Background:
Direct-to-implant breast reconstruction offers the intuitive advantages of
shortening the reconstructive process and reducing costs. In the authors’
practice, direct-to-implant breast reconstruction has evolved from dual-plane
to prepectoral implant placement. The authors sought to understand
postoperative complications and aesthetic outcomes and identify differences in
the dual-plane and prepectoral direct-to-implant subcohorts.
Methods: A retrospective
review of a prospectively maintained database was conducted from November of
2014 to March of 2018. Postoperative complication data, reoperation, and
aesthetic outcomes were reviewed. Aesthetic outcomes were evaluated by a
blinded panel of practitioners using standardized photographs.
Results: One hundred
thirty-four direct-to-implant reconstructions were performed in 81 women: 42.5
percent were dual-plane (n = 57) and 57.5 percent were prepectoral (n = 77).
Statistical analysis was limited to patients with at least 1 year of follow-up.
Total complications were low overall (8 percent), although the incidence of
prepectoral complications [n = 1 (2 percent)] was lower than the incidence of
dual-plane complications [n = 7 (12 percent)], with the difference approaching
statistical significance (p = 0.07). Panel evaluation for aesthetic outcomes
favored prepectoral reconstruction. Pectoralis animation deformity was
completely eliminated in the prepectoral cohort.
Conclusions: The authors
present the largest comparative direct-to-implant series using acellular dermal
matrix to date. Transition to prepectoral direct-to-implant reconstruction has
not resulted in increased complications, degradation of aesthetic results, or
an increase in revision procedures. Prepectoral reconstruction is a viable
reconstructive option with elimination of animation deformity and potential for
enhanced aesthetic results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic,
III.
