Implant-Based Immediate Breast Reconstruction: Pre-pectoral vs. Sub-pectoral—An Outcome Analysis

Abstract

Implant-based breast reconstruction (IBR) is the most common reconstructive procedure after mastectomy. In the last years pre-pectoral IBR gained popularity over the sub-pectoral technique but long-term outcomes are still unavailable. The aim is to compare the clinical outcomes of different approaches to IBR (direct-to-implant (DTI) and expander-to-implant (ETI), pre-pectoral and sub-pectoral techniques). A retrospective review of all patients undergoing immediate IBR from April 2011 to April 2019 under the care of a single plastic surgeon was performed. A total of 106 patients (138 breasts) underwent mastectomy and IBR. Although no significant statistical differences were identified, the incidence of skin necrosis was lower in ETI reconstructions. Pre-pectoral reconstructions had a shorter length of hospital stay. ETI sub-pectoral IBR confirms to be the safest option albeit requiring two surgical procedures. DTI pre-pectoral IBR seems to be related with a higher rate of implant loss if a complication happens. Conversely, in DTI sub-pectoral IBR complications can be more often managed conservatively.