Prepectoral Passot-Type Immediate Breast Reconstruction With the Use of Acellular Dermal Matrix in Grades 2 and 3 Ptosis.

Introduction: Implant-based breast reconstruction after skin-sparing mastectomy remains one of the most frequently used methods of breast reconstruction in the US. Patients with large, ptotic breasts often face poorer outcomes. We hypothesized that implant-based breast reconstruction with auto-augmentation techniques can minimize problems with acellular dermal matrices (ADM) by using less, and providing the benefit of prepectoral placement.

Methods: We performed a single institution retrospective review of all patients with grade 2 or 3 ptosis following subpectoral and prepectoral BR with autologous dermal tissue and/or ADM over a 5-year period. Outcomes, complications, and costs between the subpectoral, prepectoral, and tissue expander (TE) with ADM groups were compared within our sample.

Results: Women in the Passot-type reconstruction groups had significantly higher body mass indices and rates of radiation therapy. When body mass index and radiation were controlled for, there were no significant differences in complication rates between prepectoral Passot, subpectoral Passot, and the TE/ADM group. Passot-type reconstructions can be significantly less expensive than TE/ADM.

Conclusions: Prepectoral Passot-type reconstruction is a viable method to limit complications of subpectoral approaches at roughly half the cost of a TE/ADM approach.