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Prepectoral vs. Submuscular Prosthetic Based Immediate Breast Reconstruction
Shayda Mirhaidari, MD
Vitali Azouz, MD
Alexandre Prassinos
Douglas S. Wagner, MD
Summa Health System
2018-02-14
Presenter: Shayda Jeannette Mirhaidari
Affidavit:
I certify that the work on this project represents the original work of the resident, of which she has performed the majority of the aforementioned work.
Director Name: Douglas S. Wagner
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
BACKGROUND:
Over 88,000 implant based breast reconstructions were performed in 2016 with implant based procedures being the most common method of postmastectomy breast reconstruction. While various methods for reconstruction techniques have been described, partial submuscular implant placement with or without acellular dermal matrix coverage remains the standard approach. Recently prepectoral implant placement has gained increasing recognition as a potential way to avoid some of the morbidities of submuscular implant placement. Proponents of this technique have advocated easier postoperative recovery and improved aesthetic outcomes. The purpose of this study was to evaluate the complications after prepectoral prosthetic based immediate breast reconstruction.
METHODS:
A retrospective review of patients undergoing prepectoral prosthetic based immediate breast reconstructions (IBRs) from February 2016 to November 2017 was performed. The incidence of complications such as mastectomy skin flap necrosis, seroma, hematoma, infection, implant loss, and unexpected reoperation were recorded and compared to a historical cohort of patients undergoing submuscular prosthetic based IBR in the period immediately prior.
RESULTS:
There were 62 patients who underwent 112 prepectoral implant based IBRs. There were 4 (3.6%) breasts diagnosed with infection. There were 7 (6.3%) breasts that suffered from MSFN. There was one implant loss related to full thickness necrosis that required salvage with autologous tissue reconstruction. The reoperation rate for ischemia was 5.4%.
CONCLUSION:
Prepectoral implant placement is a safe and reasonable approach for IBR. Complication rates compare favorably to the standard submuscular technique and may have the added benefit of improved aesthetic outcomes and easier postoperative recovery.
