by Wormer, Blair A.;
Valmadrid, Al C.; Ganesh Kumar, Nishant; Al Kassis, Salam; Rankin, Timothy M.;
Kaoutzanis, Christodoulos; Higdon, Kent K.
Background: The numerous office visits required to complete expansion in
implant-based breast reconstruction impact patient satisfaction, office
resources, and time to complete reconstruction. This study aimed to determine
whether prepectoral compared to subpectoral immediate implant-based breast
reconstruction offers expedited tissue expansion without affecting complication
rates.
Methods: Consecutive patients who underwent immediate implant-based breast
reconstruction with tissue expanders from January of 2016 to July of 2017 by a
single surgeon were grouped into subpectoral (partial submuscular/partial
acellular dermal matrix) or prepectoral (complete acellular dermal matrix
coverage), and reviewed. The primary outcomes were total days and number of
visits to complete expansion. Groups were compared by univariate analysis with
significance set at p < 0.05.
Results: In total, 101 patients (subpectoral, n = 69; prepectoral, n = 32)
underwent 184 immediate implant-based breast reconstructions (subpectoral, n =
124; prepectoral, n = 60). There was no difference in age, body mass index,
smoking, or diabetes between the groups (all p > 0.05). Follow-up was
similar between groups (179.3 ± 98.2 days versus 218.3 ± 119.8 days; p =
0.115). Prepectoral patients took fewer days to complete expansion (40.4 ± 37.8
days versus 62.5 ± 50.2 days; p < 0.001) and fewer office visits to complete
expansion (2.3 ± 1 .7 versus 3.9 ± 1.8; p < 0.001), and were expanded to
greater final volumes than subpectoral patients (543.7 ± 122.9 ml versus 477.5
± 159.6 ml; p = 0.017). Between prepectoral and subpectoral reconstructions,
there were similar rates of minor complications (25 percent versus 18.5
percent; p = 0.311), readmissions (5 percent versus 2.4 percent; p = 0.393),
seromas (8.3 percent versus 5.6 percent; p = 0.489), reoperations for hematoma
(3.3 percent versus 1.6 percent; p = 0.597), and explantations (5 percent
versus 2.4 percent; p = 0.393).
Conclusion: This novel analysis demonstrates that prepectoral immediate
implant-based breast reconstruction can facilitate expansion to higher total
volumes in nearly half the office visits compared to subpectoral placement in
similar populations without increasing complication rates. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
