Immediate One-Stage Implant-Based Breast Reconstruction after Conservative Mastectomy: Sub-Pectoral or Pre-Pectoral? A Proposal for a Randomized Multicentric Trial to Define Indications and Outcomes.

Abstract

Background: Implant-based breast reconstruction (IBR) is the most common reconstructive procedure after mastectomy. During the last 10-15 years, the introduction of Acellular Dermal Matrices (ADMs)/synthetic meshes has driven a change in practice from complete submuscular implants to sub-pectoral implants. In the last 5-7 years pre-pectoral IBR with complete ADM/mesh cover gained popularity as an alternative to sub-pectoral IBR and is considered the procedure of choice in athletic, active women. Avoiding disturbance of muscular structures has the theoretical advantages of reduced post-operative pain and operative time and prevention of animation deformity. However, long-term outcomes are still not available and possible disadvantages of pre-pectoral IBR might be increased palpability of implant edges and upper pole wrinkling, possibly leading to more revisional surgery.