by Avila, Azalia; Bartholomew, Alex J.; Sosin, Michael;
Deldar, Romina; Griffith, Kayla F.; Willey, Shawna C.; Song, David H.; Fan,
Kenneth L.; Tousimis, Eleni A.
Plastic and
Reconstructive Surgery: December 2020
- Volume 146 - Issue 6 - p 715e-720e
Background:
Nipple-sparing mastectomy is associated with improved
aesthetics and oncologic safety. Recently, there has been a resurgence in
prepectoral reconstruction. Because of limited data comparing complication
rates on patients undergoing prepectoral breast reconstruction, this study
compared 30-day postoperative complications by plane of prosthetic placement.
Methods:
A retrospective review was conducted on all consecutive
patients undergoing nipple-sparing mastectomy with implant-based reconstruction
with either prepectoral or subpectoral placement from 2014 to 2018. The primary
outcome was a composite, acute 30-day postoperative complication, including
nipple-areola complex necrosis, mastectomy flap necrosis, wound dehiscence,
infection, hematoma, and seroma. Secondary outcomes included nipple loss and
rates of unintended reoperations. Univariate and mixed effects multivariate
logistic regression were used to compare outcomes.
Results:
A total of 228 patients and 405 breasts were included in the
final cohort, with 202 in the subpectoral cohort and 203 in the prepectoral
cohort. The overall complication rate was 7.65 percent, with no significant difference
between subpectoral and prepectoral cohorts (9.41 percent versus 5.91 percent,
respectively; p = 0.148). Prepectoral reconstruction was associated with
significantly reduced ischemic complications, including nipple loss because of
necrosis (2.97 percent versus 0.49 percent, respectively; p = 0.015) and
mastectomy flap necrosis (5.45 percent versus 0 percent; p = 0.003). There were
no significant differences in rates of infection, hematoma, seroma, or implant
loss/exchange.
Conclusions:
Prepectoral reconstruction is associated with similar
overall 30-day postoperative complications and reoperations compared to
traditional subpectoral implants. However, prepectoral reconstruction was
associated with significantly decreased ischemic complications, including
mastectomy flap necrosis and nipple-areola complex loss because of necrosis.
Clinical Question/Level of Evidence: Therapeutic, III.
