Long-Term Clinical Outcomes and Cost-Utility Analysis of Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Multicenter Retrospective Cohort Study

IF 2.7 3区医学 Q2 ONCOLOGY

Clinical breast cancer Pub Date : 2026-08-01 Epub Date: 2026-06-24 DOI:10.1016/j.clbc.2026.06.009

Federica Grieco, Marco Driutti, Emma Zanin, Eleonora Bassi, Elena Galvano, Luigi Castriotta, Stefano Ivan Coppola, Pier Camillo Parodi, Nicola Zingaretti

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引用次数: 0

Abstract

Background

Immediate direct-to-implant (DTI) reconstruction after nipple-sparing mastectomy (NSM) can be performed prepectorally or subpectorally, with variable use of implant-supporting mesh. We compared long-term clinical outcomes and cost-utility of 3 DTI strategies.

Methods

Consecutive adult women undergoing NSM with immediate DTI at 2 tertiary centers in northeastern Italy (January 1, 2011-Decmeber 31, 2024) were included. Cohorts: prepectoral DTI with mesh, dual-plane subpectoral DTI with mesh, and subpectoral DTI without mesh. Primary outcome: cumulative reconstruction-related reoperation. Secondary outcomes: early (≤ 90 days) and late (> 90 days) complications. EQ-5D-5L utilities were collected prospectively; Quality-Adjusted Life Years (QALYs) were estimated by trapezoidal integration. Hospital/provider costs were captured and standardized to 2024 €; base-case horizon 10 years with 3.5% annual discounting. Probabilistic sensitivity analysis (PSA) (10,000 iterations) quantified uncertainty.

Results

Of 416 patients (501 reconstructions): prepectoral + mesh n = 215 (42.9%), subpectoral + mesh n = 144 (28.7%), subpectoral no mesh n = 142 (28.3%). Median follow-up 5.9 years. Cumulative reoperation: 13.95% (prepectoral + mesh), 27.08% (subpectoral + mesh), 21.83% (subpectoral no mesh) (P = .008). Mean observed total cost per patient: €8798.50 (prepectoral + mesh), €5235.28 (subpectoral + mesh), €3227.17 (subpectoral no mesh) (P < .001). Time-weighted mean EQ-5D-5L utilities ≈0.830 (prepectoral) versus ≈0.801 (pooled subpectoral). Ten-year discounted base-case: incremental cost ≈€4567 and incremental cost-utility ratio (ICUR) ≈€17,566/QALY for prepectoral versus pooled subpectoral. PSA: ≈68% probability prepectoral is cost-effective at €20,000/QALY.

Conclusions

Prepectoral DTI with mesh was associated with fewer late complications and reoperations and higher QALYs, at higher upfront cost; some mesh techniques showed increased early seroma/infection rates.

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保留乳头乳房切除术后胸前与胸下植体乳房重建术的长期临床结果和成本-效用分析：一项多中心回顾性队列研究。

背景：保留乳头乳房切除术（NSM）后立即直接植入（DTI）重建可以在胸前或胸下进行，使用不同的植入物支撑网。我们比较了3种DTI策略的长期临床结果和成本-效用。方法：纳入2011年1月1日至2024年12月31日在意大利东北部2个三级中心连续接受NSM并立即DTI的成年女性。队列：带补片的胸前DTI，带补片的双平面胸下DTI和不带补片的胸下DTI。主要结果：累积重建相关的再手术。次要结局：早期（≤90天）和晚期（> 90天）并发症。前瞻性收集EQ-5D-5L效用；采用梯形积分法估算质量调整生命年（QALYs）。医院/供应商的费用被记录下来并标准化到2024欧元；基本情况是10年，年折扣率为3.5%。概率敏感性分析（PSA）（10,000次迭代）量化了不确定性。结果：416例（501例）中，胸前+补片215例（42.9%），胸下+补片144例（28.7%），胸下无补片142例（28.3%）。中位随访5.9年。累计再手术率：13.95%（胸前+补片），27.08%（胸下+补片），21.83%（胸下无补片）（P = 0.008）。每位患者平均观察总成本：8798.50欧元（胸前+补片），5235.28欧元（胸下+补片），3227.17欧元（胸下无补片）（P < 0.001）。时间加权平均EQ-5D-5L效用≈0.830（胸前）vs≈0.801（合并胸下）。十年折扣基本情况：滨海区与滨海区合并的增量成本≈4567欧元，增量成本效用比(ICUR)≈17566欧元/QALY。PSA：约68%的概率预选成本效益为20,000欧元/QALY。结论：术前补片DTI晚期并发症和再手术较少，qaly较高，前期成本较高；一些网状技术显示早期血肿/感染率增加。

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来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.