by Baker,
Benjamin G.; Irri, Renu; MacCallum, Vivienne; Chattopadhyay, Rahul; Murphy,
John; Harvey, James R.
Plastic and Reconstructive Surgery: May 2018 - Volume 141 - Issue 5 - p 1077–1084
Background: Prepectoral acellular dermal matrix–assisted immediate
implant-based breast reconstruction is gaining popularity, involving complete
implant coverage with acellular dermal matrix. The authors aimed to compare
pain, patient-reported outcome measures (including implant rippling), and
safety of prepectoral and subpectoral Strattice–assisted implant-based breast
reconstruction. Methods: Consecutive patients were recruited prospectively,
having either therapeutic or risk-reducing mastectomy. Patients scored their
pain three times per day for the first 7 postoperative days on a Likert scale,
and completed the BREAST-Q reconstruction module 3 months postoperatively.
Clinical records and the authors’ prospective complications database were used
to compare the early morbidity of the two procedures. Results: Forty patients
were recruited into the study. There was no significant difference in pain
scores between the prepectoral group (mean, 1.5) and the subpectoral cohort
(mean, 1.5; p = 0.45) during the first 7 days. Thirty-one BREAST-Q
questionnaires were returned; mean Q scores were similar for both prepectoral
and subpectoral (72 and 71, respectively; p = 0.81) groups. Patients reported significantly
more visible implant rippling in the prepectoral group than in the subpectoral
group (seven of 13 versus two of 17; p = 0.02). There was no significant
difference in length of stay or early morbidity, with implant loss being 4.7
percent in the prepectoral group compared with 0 percent in the subpectoral
group. Conclusions: Early postoperative pain and quality of life at 3 months
are equivalent between groups. Early experience of prepectoral implant
placement with complete acellular dermal matrix coverage suggests this is safe
and provides good quality of life for patients. Further studies are required to
compare short- and long-term outcomes with the current standard forms of
reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
