Prepectoral vs Subpectoral Implant-Based Breast Reconstruction: Evaluating the Shift.

IF 3.4 2区医学 Q1 SURGERY

Plastic and reconstructive surgery Pub Date : 2025-10-06 DOI:10.1097/PRS.0000000000012480

Holly Cordray, Salman Khan, Malia Voytik, Justus Zemberi, Gustavo Capone, Ashley E Chang, Robyn B Broach, Saïd C Azoury

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引用次数: 0

Abstract

Background: This study evaluated trends in implant-based breast reconstruction, anticipating a shift toward prepectoral implants instead of subpectoral implants, and correlated these shifts with clinical outcomes.

Methods: The cohort included adult patients who received implant-based breast reconstruction at the University of Pennsylvania Health System from 2018-2024. Analyses used linear regression to trend implant plane selection over time, and Chi-square/Fisher's tests with relative risk (RR) to compare postoperative complications by reconstructive approach.

Results: Among 686 patients, reconstructions were subpectoral (301 cases) or prepectoral (385 cases). Prepectoral reconstructions rose significantly across the study period (P = .001), from 4.0% of cases in 2018 to 90.2% in 2024. Prepectoral reconstructions showed significantly lower incidence of postoperative fat necrosis (RR 0.3, 95% CI: 0.1-0.9), nipple-areolar complex necrosis (RR 0.2, CI: 0.1-0.5), and chronic pain (RR 0.3, CI: 0.1-0.8). Prepectoral reconstructions showed significantly higher incidence of infection (RR 3.3, CI: 2.0-5.5), delayed healing/dehiscence (RR 2.0, CI: 1.3-2.9), readmission (RR 2.1, CI: 1.2-3.6), and reoperation for complications (RR 2.0, CI: 1.5-2.8). Prepectoral reconstructions showed higher reoperation rates for threatened prosthetic loss (RR 2.9, CI: 1.7-4.9) and prosthetic failure rates (RR 2.8, 1.5-5.2).

Conclusions: Implant plane preference reversed across 2018-2024, from subpectoral to prepectoral. Despite certain advantages, prepectoral (vs subpectoral) reconstructions showed twice the risk of readmission and reoperation, including nearly threefold risk of reoperation for threatened prosthetic loss and ultimate failure. These results warrant further study to determine ways to improve outcomes following prepectoral reconstruction or whether surgeons should revisit subpectoral placement in predetermined high-risk cases.

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胸前与胸下植体乳房重建：评估移位。

背景：本研究评估了以假体为基础的乳房重建的趋势，预测了向胸前假体而不是胸下假体的转变，并将这些转变与临床结果联系起来。方法：该队列包括2018-2024年在宾夕法尼亚大学卫生系统接受假体乳房重建的成年患者。采用线性回归分析种植体平面选择随时间的变化趋势，采用相对风险（RR）卡方/Fisher检验比较重建入路术后并发症。结果：686例患者中，胸下重建301例，胸前重建385例。在整个研究期间，直肠重建率显著上升（P = 0.001），从2018年的4.0%上升到2024年的90.2%。胸前重建术后脂肪坏死（RR = 0.3, 95% CI: 0.1-0.9）、乳头-乳晕复合坏死（RR = 0.2, CI = 0.1-0.5）和慢性疼痛（RR = 0.3, CI = 0.1-0.8）的发生率明显降低。术前重建术的感染率（RR 3.3, CI: 2.0-5.5）、延迟愈合/开裂（RR 2.0, CI: 1.3-2.9）、再入院（RR 2.1, CI: 1.2-3.6）和并发症再手术（RR 2.0, CI: 1.5-2.8）的发生率显著高于术前重建术。胸前重建显示，假体丢失威胁的再手术率（RR为2.9，CI为1.7-4.9）和假体失效率（RR为2.8,1.5-5.2）较高。结论：2018-2024年间，植入物平面偏好从胸下到胸前发生了逆转。尽管有一定的优势，胸前重建（与胸下重建相比）再次入院和再手术的风险是前者的两倍，其中因假体丢失和最终失败而再次手术的风险几乎是后者的三倍。这些结果值得进一步研究，以确定改善胸前重建的方法，或者外科医生是否应该在预先确定的高危病例中重新考虑胸下置入术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.