by Nealon, Kassandra P.; Weitzman, Rachel E.;
Sobti, Nikhil; Gadd, Michele; Specht, Michelle; Jimenez, Rachel B.; Ehrlichman,
Richard; Faulkner, Heather R.; Austen, William G. Jr; Liao, Eric C.
Background: Continued
evolution of implant-based breast reconstruction involves immediate placement
of the implant above the pectoralis muscle. The shift to prepectoral breast
reconstruction is driven by goals of decreasing morbidity such as breast
animation deformity, range-of-motion problems, and pain, and is made possible
by improvements in mastectomy skin flap viability. To define clinical factors
to guide patient selection for direct-to-implant prepectoral implant
reconstruction, this study compares safety endpoints and risk factors between
prepectoral and subpectoral direct-to-implant breast reconstruction cohorts.
The authors hypothesized that prepectoral direct-to-implant breast reconstruction
is a safe alternative to subpectoral direct-to-implant breast reconstruction.
Methods:
Retrospective chart review identified patients who underwent prepectoral and
subpectoral direct-to-implant breast reconstruction, performed by a team of five
surgical oncologists and two plastic surgeons. Univariate analysis compared
patient characteristics between cohorts. A penalized logistic regression model
was constructed to identify relationships between postoperative complications
and covariate risk factors.
Results: A cohort
of 114 prepectoral direct-to-implant patients was compared with 142 subpectoral
direct-to-implant patients. The results of the penalized regression model
demonstrated equivalence in safety metrics between prepectoral direct-to-implant
and subpectoral direct-to-implant breast reconstruction, including seroma (p =
0.0883), cancer recurrence (p = 0.876), explantation (p = 0.992), capsular
contracture (p = 0.158), mastectomy skin flap necrosis (p = 0.769), infection
(p = 0.523), hematoma (p = 0.228), and revision (p = 0.122).
Conclusions: This study
demonstrates that prepectoral direct-to-implant reconstruction is a safe
alternative to subpectoral direct-to-implant reconstruction. Given the low
morbidity and elimination of animation deformity, prepectoral direct-to-implant
reconstruction should be considered when the mastectomy skin flap is robust.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
