Jennifer Wang, Ronnie L Shammas, Elizabeth Montes-Smith, Lillian A Boe, Jacob Levy, Francis D Graziano, Carrie S Stern, Jonas A Nelson, Joseph J Disa
{"title":"保留乳头乳房切除术后乳房前与肌肉下乳房重建的并发症和患者报告的结果。","authors":"Jennifer Wang, Ronnie L Shammas, Elizabeth Montes-Smith, Lillian A Boe, Jacob Levy, Francis D Graziano, Carrie S Stern, Jonas A Nelson, Joseph J Disa","doi":"10.1097/PRS.0000000000012096","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Preprectoral breast reconstruction and nipple-sparing mastectomy (NSM) have both risen in popularity because of advances in reconstructive techniques. However, it is unknown whether exposed lactiferous ducts in an NSM may increase the risk for infection after prepectoral implant-based breast reconstruction. The authors aimed to assess complication rates and BREAST-Q physical well-being of the chest scores in patients who underwent NSM and implant-based breast reconstruction in a prepectoral versus submuscular plane.</p><p><strong>Methods: </strong>A retrospective review was performed of patients who underwent NSM with 2-stage implant-based reconstruction from 2013 to 2023. Patients were grouped by prepectoral or submuscular placement. Postoperative complications and BREAST-Q scores were assessed after surgery.</p><p><strong>Results: </strong>A total of 693 patients were included: 345 underwent prepectoral and 348 underwent submuscular reconstruction. Surgical-site infection occurred in 10% of prepectoral patients and 5.7% of submuscular patients ( P = 0.03). Seroma occurred in 15% of prepectoral patients and 6.6% of submuscular patients ( P < 0.001). Multivariable analysis showed that prepectoral patients had significantly increased odds of developing surgical-site infection and seroma compared with submuscular patients (OR, 1.87; P = 0.04 and OR, 2.52; P < 0.001, respectively). However, prepectoral reconstruction was associated with significantly higher BREAST-Q physical well-being of the chest scores as compared with submuscular implant placement (β, 3.4; P = 0.01).</p><p><strong>Conclusions: </strong>Prepectoral reconstruction following NSM is associated with higher rates of surgical-site infection and seroma but improved physical well-being of the chest compared with submuscular implant placement following NSM. An increased risk of infection and seroma should be weighed against improved patient-reported outcomes when deciding on implant plane placement after NSM.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"513-520"},"PeriodicalIF":3.4000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prepectoral versus Submuscular Breast Reconstruction after Nipple-Sparing Mastectomy: Complications and Outcomes.\",\"authors\":\"Jennifer Wang, Ronnie L Shammas, Elizabeth Montes-Smith, Lillian A Boe, Jacob Levy, Francis D Graziano, Carrie S Stern, Jonas A Nelson, Joseph J Disa\",\"doi\":\"10.1097/PRS.0000000000012096\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Preprectoral breast reconstruction and nipple-sparing mastectomy (NSM) have both risen in popularity because of advances in reconstructive techniques. However, it is unknown whether exposed lactiferous ducts in an NSM may increase the risk for infection after prepectoral implant-based breast reconstruction. The authors aimed to assess complication rates and BREAST-Q physical well-being of the chest scores in patients who underwent NSM and implant-based breast reconstruction in a prepectoral versus submuscular plane.</p><p><strong>Methods: </strong>A retrospective review was performed of patients who underwent NSM with 2-stage implant-based reconstruction from 2013 to 2023. Patients were grouped by prepectoral or submuscular placement. Postoperative complications and BREAST-Q scores were assessed after surgery.</p><p><strong>Results: </strong>A total of 693 patients were included: 345 underwent prepectoral and 348 underwent submuscular reconstruction. Surgical-site infection occurred in 10% of prepectoral patients and 5.7% of submuscular patients ( P = 0.03). Seroma occurred in 15% of prepectoral patients and 6.6% of submuscular patients ( P < 0.001). Multivariable analysis showed that prepectoral patients had significantly increased odds of developing surgical-site infection and seroma compared with submuscular patients (OR, 1.87; P = 0.04 and OR, 2.52; P < 0.001, respectively). However, prepectoral reconstruction was associated with significantly higher BREAST-Q physical well-being of the chest scores as compared with submuscular implant placement (β, 3.4; P = 0.01).</p><p><strong>Conclusions: </strong>Prepectoral reconstruction following NSM is associated with higher rates of surgical-site infection and seroma but improved physical well-being of the chest compared with submuscular implant placement following NSM. An increased risk of infection and seroma should be weighed against improved patient-reported outcomes when deciding on implant plane placement after NSM.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>\",\"PeriodicalId\":20128,\"journal\":{\"name\":\"Plastic and reconstructive surgery\",\"volume\":\" \",\"pages\":\"513-520\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Plastic and reconstructive surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PRS.0000000000012096\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Plastic and reconstructive surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PRS.0000000000012096","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Prepectoral versus Submuscular Breast Reconstruction after Nipple-Sparing Mastectomy: Complications and Outcomes.
Background: Preprectoral breast reconstruction and nipple-sparing mastectomy (NSM) have both risen in popularity because of advances in reconstructive techniques. However, it is unknown whether exposed lactiferous ducts in an NSM may increase the risk for infection after prepectoral implant-based breast reconstruction. The authors aimed to assess complication rates and BREAST-Q physical well-being of the chest scores in patients who underwent NSM and implant-based breast reconstruction in a prepectoral versus submuscular plane.
Methods: A retrospective review was performed of patients who underwent NSM with 2-stage implant-based reconstruction from 2013 to 2023. Patients were grouped by prepectoral or submuscular placement. Postoperative complications and BREAST-Q scores were assessed after surgery.
Results: A total of 693 patients were included: 345 underwent prepectoral and 348 underwent submuscular reconstruction. Surgical-site infection occurred in 10% of prepectoral patients and 5.7% of submuscular patients ( P = 0.03). Seroma occurred in 15% of prepectoral patients and 6.6% of submuscular patients ( P < 0.001). Multivariable analysis showed that prepectoral patients had significantly increased odds of developing surgical-site infection and seroma compared with submuscular patients (OR, 1.87; P = 0.04 and OR, 2.52; P < 0.001, respectively). However, prepectoral reconstruction was associated with significantly higher BREAST-Q physical well-being of the chest scores as compared with submuscular implant placement (β, 3.4; P = 0.01).
Conclusions: Prepectoral reconstruction following NSM is associated with higher rates of surgical-site infection and seroma but improved physical well-being of the chest compared with submuscular implant placement following NSM. An increased risk of infection and seroma should be weighed against improved patient-reported outcomes when deciding on implant plane placement after NSM.
Clinical question/level of evidence: Therapeutic, III.
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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.
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