American Association of Plastic Surgeons

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A Paradigm Shift In Implant-based Breast Reconstruction: An Outcomes Analysis In Prepectoral Versus Subpectoral Reconstruction
Sarah Persing, MD, MPH1, Catherine J. Sinnott, MD2, Mary Pronovost, MD, MSN3, Christine Hodyl, DO3, Robin Wu, BS4, Anke Ott-Young, MD, PhD3.
1Yale New Haven Hospital, New Haven, CT, USA, 2Nassau University Medical Center, East Meadow, NY, USA, 3Bridgeport Hospital, Bridgeport, CT, USA, 4Yale University, New Haven, CT, USA.

PURPOSE:
Implant-based breast reconstruction traditionally involves implant placement in a subpectoral plane. Prepectoral reconstruction with local throacoepigastric flap and acellular dermal matrix placement is a safe and less invasive alternative. The purpose of this study is to compare outcomes of this prepectoral technique to the subpectoral approach.
METHODS: A retrospective review of 406 patients (644 breasts) who underwent breast reconstruction by a single surgeon from 2010 to 2017 was performed. 288 patients (452 breasts) underwent prepectoral placement and 118 (192 breasts) subpectoral placement. Demographic, operative and oncologic data were collected. Outcomes of infection, flap necrosis, dehiscence, capsular contracture, seroma/hematoma, rippling, implant loss, and recurrence were also recorded.
RESULTS:
Patients in the prepectoral group were older (51.8 vs 46.5, p<0.001) and had a higher BMI than the subpectoral group (28.6 vs. 24.9, p<0.001). The prepectoral group were more likely to have chemotherapy (43.2% vs. 29.9%, p<0.001). More patients in the subpectoral group underwent adjuvant lipofilling compared to the prepectoral group (64% vs. 26.9%; p<0.001). The capsular contraction rate in the prepectoral group was less than the subpectoral group (4.9% vs. 8.9%; p=0.052). Implant loss, infection, flap necrosis, seroma/hematoma, rippling and local recurrence rates were similar between the two groups.
CONCLUSIONS: Prepectoral implant-based breast reconstruction is safe and less invasive than the traditional subpectoral technique, with similar complication rates. Capsular contracture rates in the prepectoral group were nearly half that compared to the subpectoral approach. Further research is needed to better characterize this lower rate of capsular contracture in the prepectoral group.


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