An 11-year retrospective analysis of clinical outcomes after prepectoral implant-based breast reconstruction performed by a single surgeon

Abstract

Background: Prepectoral implant breast reconstruction is being offered to an increasing number of breast cancer patients because it results in less postoperative pain, faster recovery and a lower risk of animation deformity compared to subpectoral reconstruction. However, broad acceptance of this muscle-sparing procedure is still slow secondary to safety concerns, including an increased risk of capsular contracture, implant exposure, implant visibility and delayed detection of breast cancer recurrence. This study aimed to describe clinical outcomes in prepectoral breast reconstruction performed by a single surgeon over an 11-year period. Methods: A retrospective chart review was conducted of all patients who had prepectoral or subpectoral implant breast reconstruction from 2010 to 2021. Demographic, clinical and operative data were assessed. Outcomes were determined by comparing complication rates between prepectoral and subpectoral implant reconstruction, including, mastectomy necrosis, seroma, hematoma, dehiscence and local recurrence. Results: A total of 758 prepectoral reconstructions were performed in 468 patients with a mean age of 52.5±9.9 (± SD) years and mean body mass index (BMI) of 28.8±6.1 kg/m 2 . A total of 163 subpectoral implant reconstructions were performed in 100 patients with a mean age of 46.9±8.8 years and mean BMI of 25.2±5.0 kg/m 2 . Complication rates in prepectoral implant reconstruction patients were low and comparable to subpectoral patients, with regard to major infection (3.4% vs. 1.2%), major necrosis (1.7% vs. 1.2%), capsular contracture (6.5% vs. 9.8%), implant loss (4.1% vs. 4.3%), seroma (0.3% vs. 1.2%), hematoma (0.3% vs. 0%), dehiscence (0.7% vs. 1.2%), local recurrence (1.3% vs. 1.2%) and total complications (22.7% vs. 22.1%; P>0.1462), respectively. Postmastectomy radiation and therapeutic reconstruction were risk factors for a complication in prepectoral implant reconstruction. Conclusions: Prepectoral implant reconstruction is associated with low complication rates comparable to subpectoral implant reconstruction. Rates of capsular contracture, implant exposure and local recurrence were not increased with prepectoral reconstruction. Prepectoral implant reconstruction should be offered to breast cancer patients in settings where there is an experienced team of oncoplastic surgeons because of its decreased invasiveness, postoperative pain and low complication rates.