Timeline and Incidence of Postoperative Complications in Prepectoral, Dual-Plane, and Total Submuscular Alloplastic Reconstruction With and Without Biosynthetic Scaffold Usage

Abstract

Introduction: Acellular dermal matrices and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over the surgical technique in implant-based breast reconstruction. The aims of this study are to compare various combinations of placement planes and biosynthetic scaffolds and to further examine the respective incidences of postoperative complications and the timeline of capsular contracture development.

Methods: A data set consisting of 220 patients (393 samples) who underwent 2-stage reconstruction between 2012 and 2021 was used in the study. χ 2 , Fisher exact test, and 1-way analysis of variance were used to identify significant differences between the 4 subgroups. Cox proportional-hazards model and Kaplan-Meier estimator were used for survival analysis.

Results: On univariate logistic regression (odds ratio, 0.21; P = 0.005), survival analysis ( P = 0.0082), and Cox-proportional hazard model (hazard ratio, 1.6; P = 0.01), poly-4-hydroxybutyrate mesh usage was linked to an increased risk of capsular contracture development. Prepectoral placement with no mesh and dual-plane placement with acellular dermal matrix showed similar timelines of capsular contracture development. The lowest incidences of capsular contracture occurred in the prepectoral placement and no mesh (49/161, 30.4%) and total submuscular subgroups (3/14, 21.4%). Infection, necrosis, and revision surgery rates did not differ significantly between the 4 groups.

Conclusions: The use of poly-4-hydroxybutyrate mesh in 2-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Prepectoral placement with no biosynthetic scaffold had one of the lowest rates of contracture and may provide the most optimal balance between economic and clinical considerations in implant-based reconstruction.