Arch Plast Surg.  2019 Nov;46(6):550-557. 10.5999/aps.2019.00353.

Considerations for patient selection: Prepectoral versus subpectoral implant-based breast reconstruction

• Yang JY
• Kim CW
• Lee JW
• Kim SK
• Lee SA
• Hwang E

• KMID: 2465555
• DOI: http://doi.org/10.5999/aps.2019.00353

Abstract

BACKGROUND
In recent years, breast implants have been frequently placed in the subcutaneous pocket, in the so-called prepectoral approach. We report our technique of prepectoral implant-based breast reconstruction (IBR), as well as its surgical and aesthetic outcomes, in comparison with subpectoral IBR. We also discuss relevant considerations and pitfalls in prepectoral IBR and suggest an algorithm for the selection of patients for IBR based on our experiences.
METHODS
We performed 79 immediate breast reconstructions with a breast implant and an acellular dermal matrix (ADM) sling, of which 47 were subpectoral IBRs and 32 were prepectoral IBRs. Two-stage IBR was performed in 36 cases (20 subpectoral, 16 prepectoral), and direct-to-implant IBR in 43 cases (27 prepectoral, 16 subpectoral). The ADM sling supplemented the inferolateral side of the breast prosthesis in the subpectoral group and covered the entire anterior surface of the breast prosthesis in the prepectoral group.
RESULTS
The postoperative pain score was much lower in the prepectoral group than in the subpectoral group (1.78 vs. 7.17). The incidence of seroma was higher in the prepectoral group (31.3% vs. 6.4%). Other postoperative complications, such as surgical site infection, flap necrosis, implant failure, and wound dehiscence, occurred at similar rates in both groups. Animation deformities developed in 8.5% of patients in the subpectoral group and rippling deformities were more common in the prepectoral group (21.9% vs. 12.8%).
CONCLUSIONS
The indications for prepectoral IBR include moderately-sized breasts with a thick well-vascularized mastectomy flap and concomitant bilateral breast reconstruction with prophylactic mastectomy.

Keyword

Breast neoplasms; Breast implant; Mammaplasty

MeSH Terms

Acellular Dermis
Breast Implants
Breast Neoplasms
Breast*
Congenital Abnormalities
Female
Humans
Incidence
Mammaplasty*
Mastectomy
Necrosis
Pain, Postoperative
Patient Selection*
Postoperative Complications
Prostheses and Implants
Seroma
Surgical Wound Infection
Wounds and Injuries