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. 2019 Nov;46(6):550-557.
doi: 10.5999/aps.2019.00353. Epub 2019 Nov 15.

Considerations for patient selection: Prepectoral versus subpectoral implant-based breast reconstruction

Jun Young Yang  1 , Chan Woo Kim  1 , Jang Won Lee  1 , Seung Ki Kim  2 , Seung Ah Lee  2 , Euna Hwang  1
Affiliations

Considerations for patient selection: Prepectoral versus subpectoral implant-based breast reconstruction

Jun Young Yang et al. Arch Plast Surg. 2019 Nov.

Abstract

Background: In recent years, breast implants have been frequently placed in the subcutaneous pocket, in the so-called prepectoral approach. We report our technique of prepectoral implant-based breast reconstruction (IBR), as well as its surgical and aesthetic outcomes, in comparison with subpectoral IBR. We also discuss relevant considerations and pitfalls in prepectoral IBR and suggest an algorithm for the selection of patients for IBR based on our experiences.

Methods: We performed 79 immediate breast reconstructions with a breast implant and an acellular dermal matrix (ADM) sling, of which 47 were subpectoral IBRs and 32 were prepectoral IBRs. Two-stage IBR was performed in 36 cases (20 subpectoral, 16 prepectoral), and direct-to-implant IBR in 43 cases (27 prepectoral, 16 subpectoral). The ADM sling supplemented the inferolateral side of the breast prosthesis in the subpectoral group and covered the entire anterior surface of the breast prosthesis in the prepectoral group.

Results: The postoperative pain score was much lower in the prepectoral group than in the subpectoral group (1.78 vs. 7.17). The incidence of seroma was higher in the prepectoral group (31.3% vs. 6.4%). Other postoperative complications, such as surgical site infection, flap necrosis, implant failure, and wound dehiscence, occurred at similar rates in both groups. Animation deformities developed in 8.5% of patients in the subpectoral group and rippling deformities were more common in the prepectoral group (21.9% vs. 12.8%).

Conclusions: The indications for prepectoral IBR include moderately-sized breasts with a thick well-vascularized mastectomy flap and concomitant bilateral breast reconstruction with prophylactic mastectomy.

Keywords: Breast implant; Breast neoplasms; Mammaplasty.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.. Surgical technique of prepectoral implant-based breast reconstruction
(A) Acellular dermal matrix (ADM) for prepectoral breast reconstruction. A 14×16 cm or 14×18 cm piece of ADM with a 2.5- to 3-mm thickness. (B) The superolateral side of the ADM was cut out and added to the inferolateral side of the ADM to elongate it to completely cover the inferolateral side of the breast implant. A 1- to 2-cm-long cuff of the ADM was folded in a groove pattern to support the breast implant along the inframammary fold. (C) Anterior view of the prepectoral reconstruction. The implant was positioned in the prepectoral space and covered with an ADM mesh. (D) Lateral view of the prepectoral reconstruction. The inferior and superior margins of the ADM were fixed to the underlying deep fascia.
Fig. 2.
Fig. 2.. Implant-based breast reconstruction selection algorithm
MRI, magnetic resonance imaging; TE, tissue expander; NSM, nipple-sparing mastectomy; SSM, skin-sparing mastectomy; TM, total mastectomy.
See this image and copyright information in PMC

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