Subpectoral Implants Research Articles

Postoperative Outcomes of Pre-Pectoral Versus Sub-Pectoral Implant Immediate Breast Reconstruction.

Immediate breast reconstruction (IBR) techniques are rapidly evolving. We compared the results from a single-center implant IBR cohort between subpectoral and prepectoral implants with and without a mesh. We analyzed all complications and grade 2-3 complications, the implant loss rate, the surgery time, the length of stay (LOS), patient satisfaction, the interval time to adjuvant therapy and cost, with a comparison between subpectoral and prepectoral implant IBR. Subpectoral implant IBR was carried out in 529 mastectomies (62.0%) and prepectoral in 324, with a significant increase in prepectoral placement in recent years. Mesh was used in 176 prepectoral placements (54.3%). Any grade of complication was reported in 147 mastectomies (17.2%), with a significantly higher rate for prepectoral implant IBR (p = 0.036). Regression analysis showed that prepectoral implant was not significantly associated with any grade of complication or with grade 2-3 complications. Prepectoral implant IBR was associated with a significantly shorter operative time and lower LOS. Grade 2-3 complications were significantly associated with lower satisfaction. Higher costs were significantly associated with the subpectoral placement and mesh. A complication rate predictive score identified five groups with a significant increase in grade 2-3 complications. Prepectoral-M-IBR increased over time with no difference in complication rates compared to subpectoral-M-IBR. Prepectoral implant placement can be considered a safe technique.

Outcomes of a same day discharge protocol in patients undergoing mastectomy and implant reconstruction.

Finite hospital resources has required a closer look at resource allocation. This has prompted a shift toward same day surgeries and a focus on reducing hospital readmissions. Following the institution of a same day discharge protocol for mastectomy and mastectomy with immediate reconstruction, we sought to assess differences in the length of stay and readmission rates. This retrospective review evaluates all cases of mastectomy with or without immediate reconstruction performed at a single high-volume center between June 2019 and March 2021. Average length of stay, 30-day readmission rates, Anesthesia Society Assessment class, and type of immediate reconstruction were assessed. Autologous reconstructions were excluded. A total of 413 patients underwent mastectomy with or without reconstruction (n=148 pre protocol and n=265 during protocol) between June 2019 and March 2021. Of those 413 patients, 180 underwent reconstruction (n=62 pre protocol and n=118 during protocol). The average length of stay after mastectomy following the implementation of the same day discharge protocol was decreased at 0.6days (n=265) compared to preimplementation at 1.02days (n=148), p<0.001. The 30-day readmission rate was not significant between the groups, p=0.13. A total of 180 patients underwent immediate reconstruction after mastectomy. The average length of stay after mastectomy with immediate reconstruction following implementation of the same day discharge protocol was shorter than preimplementation at 1.05days preimplementation (n=62) versus 0.58days following implementation (n=118), p<0.001; this finding was significant for both prepectoral and subpectoral implants, p<0.001. There was no significant difference in 30-day readmission rates between the groups with immediate reconstruction, p=0.34. Same day discharge for mastectomy with reconstruction is as safe as the more widely recognized same day discharge practice for patients with mastectomy alone.

Comparison between Pre-Pectoral and Post-Pectoral Implant Reconstruction and Different Radiation Modalities on Breast Reconstruction Complications

Single Stage direct to implant (DTI) is a rising reconstruction approach. It has been speculated that prepectoral implant placement reduces reconstruction complications as well as using newer postmastectomy radiation (PMRT) modalities as protons. Largest series in this topic included 350 DTI patients with less than 30 patients receiving PMRT. We reviewed the charts of 2,187 patients (pts) who underwent mastectomy and reconstruction at our institution between 2000 and 2020. Pts only receiving DTI with and without PMRT were included. PMRT was delivered either with 3D conformal photon +/- chest wall electron boost (CWB) or proton therapy mainly with pencil beam scanning. All pts received conventional fractionation (50-50.4 Gy in 25-28 fractions). Patients on active protons clinical trials were excluded. Primary endpoints were reconstruction complications defined as infection/necrosis (I/N) requiring debridement; capsular contracture (CC) requiring capsulotomy and overall reconstruction failure (ORF: removal of permanent implant for any complication with and without salvage reconstruction). Subgroup analysis for pts receiving PMRT was done to explore impact of proton and photons on complications. Logistic and cox regression were used. Eight hundred nine pts received DTI, with an overall median follow-up of 6.2 years. Among the entire cohort, 78/809 (9.7%) had prepectoral implants while the rest had subpectoral implants with and without alloderm support. Of the entire cohort 391/809 (48.5%) received PMRT, among those 43/391 (11%) received protons. The 5 years cumulative incidence of CC was 8.5% and 6.6% among prepectoral vs subpectoral implants (HR = 1.2, p = 0.7). The 5 years cumulative incidence of ORF was 32.2% and 28.2% among prepectoral vs subpectoral implants (HR 1.1, p = 0.6). For pts receiving PMRT, the 5 years cumulative incidence of CC were 26.0% and 8.6% among protons vs photons (HR 3.7, p < 0.0005). The 5 years cumulative incidence of ORF were 38.2% and 30.1% among protons vs photons (HR 1.4, p = 0.2). Multivariable logistic regression analysis accounting for BMI, smoking history, diabetes, and PMRT showed no significant difference between prepectoral implants versus subpectoral coverage for CC (OR = 0.7, p = 0.5), and for ORF (OR = 0.9, p = 0.8). Subgroup multivariable analysis for those receiving PMRT only showed protons compared to photons significantly increased the risk of CC (OR = 5.3, p < 0.0001) and ORF (OR = 2.1, p = 0.03). No significant difference in I/N was noted between photons and protons or between prepectoral and subpectoral pts. For breast cancer patients receiving single stage direct to implant reconstruction with and without PMRT, prepectoral implant placement did not reduce the risk of complications. Proton therapy compared to photons significantly increased the risk of capsular contracture requiring capsulotomies and significantly increased overall reconstruction failures with implants removal.

Aesthetic transaxillary subpectoral placement of vagus nerve stimulator in children and young adults: A technical note

IntroductionVagus nerve stimulation (VNS) is a neuromodulation therapy for drug-resistant epilepsy (DRE), refractory status epilepticus, and treatment-resistant depression. The lead is tunneled into the subcutaneous space and connected to the generator, which is usually implanted in a subcutaneous pocket below the clavicle. Surgical complications in the chest region include skin breakdown or infection. An alternative approach is to perform a subclavear subpectoral implantation. In our surgical series, we report a new aesthetic implantation method for VNS generators in children and young patients: the transaxillary subpectoral placement. Materials and methodsFrom May 2021 to May 2023, 10 vagus nerve stimulation generators were placed subpectorally with a transaxillary approach by the authors. We considered operative time, surgical complications such as blood loss, infections, device migration, pain, and adverse events at follow-up. ResultsIn this surgical series, we reviewed all cases of subpectoral implantation of VNS generators in children and young adults at our institution in the last 2 years. All patients were treated with subpectoral Sentiva 1000 (Livanova PLC) insertion with axillary access by a neurosurgeon and a pediatric surgeon. The operative time was slightly longer compared to the traditional subcutaneous implant. All generators reported impedances within the optimal range. Blood loss was not significant and no other perioperative complications were reported. Patients and families were highly satisfied with the outcomes in terms of comfort and aesthetic results after surgery and at the last follow-up. No cases of infection occurred, and no malfunctions or displacements of the generator were registered at clinical follow-up. ConclusionThe transaxillary subpectoral placement of theVNS generator is an aesthetic and anatomic approach, which provides several benefits to children and young adults.

When to Consider Prepectoral Implant Conversion After Subpectoral Implant Breast Reconstruction and How to Plan It.

Many deformities occur after subpectoral implant-based breast reconstruction. Today, immediate prepectoral reconstruction with implants shows a significant increase in popularity as it has many advantages over subpectoral positioning: absence of muscle deficit, breast animation, reduced implant dislocation, less postoperative pain and easy recovery. As such, implant pocket conversion from the submuscular to prepectoral plane has become our preferred strategy for solving most problems related to the submuscular implant position. The authors performed a retrospective review (from June 2018 to December 2022) of patients who underwent prepectoral implant conversion for the correction of animation deformity, dysfunctional chronic pain, and to ameliorate poor cosmetic results. The use of acellular dermal matrix (ADM) was done in the first 7 cases, in the remaining 56 were used polyurethane-covered implants. Resolution of animation deformity, chronic pain was evaluated in addition to cosmetic results and the onset of postoperative complications. Sixty-three patients (87 breasts) underwent prepectoral implant conversion with complete resolution of animation deformity, chronic pain and improved cosmetic results. Preventive lipofilling was done in 18 patients. Complication rate included 3 periprosthetic seroma in ADMs group. All were solved after US-guided aspiration. Rippling was noted in 3 patients and edge visibility was documented in 1 patient. There are no incidences of grade III and IV capsular contracture. The prepectoral implant conversion improves functional and aesthetic results, reaching excellent outcomes. The preparation for this surgery with fat graft is considered a complementary procedure that increases the indications for prepectoral implant conversion.

Staged Mastopexy before Nipple-Sparing Mastectomy: Improving Safety and Appearance in Breast Reconstruction.

Breast reconstruction following nipple-sparing mastectomy (NSM) in patients with large or ptotic breasts remains challenging because of the risk of ischemic complications and the difficulty in managing the redundant skin envelope. Staged mastopexy or breast reduction before the mastectomy/reconstruction has been shown to decrease the risk of complications and improve clinical outcomes. A retrospective analysis was conducted of patients with a genetic predisposition to breast cancer who underwent staged breast reduction/mastopexy before NSM and reconstruction in the authors' institution. In patients with in situ disease or invasive cancer, the first stage consisted of lumpectomy and oncoplastic reduction/mastopexy. Breast reconstruction at the second stage was performed with free abdominal flaps or breast implants and acellular dermal matrix. Data regarding the ischemic complications were recorded. In total, 47 patients (84 breasts) underwent this staged approach. All patients had a genetic predisposition to breast cancer. The time interval between the two stages was 11.5 months (range, 1.3 to 23.6 months). Twelve breasts (14.3%) were reconstructed with free abdominal flaps, six (7.1%) with tissue expanders, and 66 (78.6%) with permanent subpectoral implants and acellular dermal matrix. There was one case of postoperative superficial nipple-areola complex epidermolysis (1.2%), and two cases of partial mastectomy skin flap necrosis (2.4%). The mean follow-up time after completion of reconstruction was 8.3 months. Mastopexy or breast reduction before NSM and reconstruction is a safe procedure with a low risk of ischemic complications. Therapeutic, IV.

Quantifying the Impact of Prepectoral Implant Conversion on Patient Satisfaction and Quality of Life.

Conversion of subpectoral reconstruction to the prepectoral plane has been increasing in popularity. However, there is a paucity of research assessing patient-reported outcomes after this operation. The primary aim of this study was to examine patient-reported outcomes after conversion of implants from the subpectoral to prepectoral plane using the BREAST-Q. The authors retrospectively examined patients who underwent subpectoral-to-prepectoral implant conversion by three surgeons at two separate centers from 2017 through 2021. Patient demographics, primary indication for the conversion, surgical characteristics, postoperative outcomes, and BREAST-Q scores were obtained. Sixty-eight breasts in 39 patients underwent implant conversion. The most common primary indications for implant conversion were chronic pain (41%), animation deformity (31%), and cosmetic concerns (28%). Average BREAST-Q scores improved significantly preoperatively to postoperatively in all the domains measured (satisfaction with breasts, satisfaction with implants, physical well-being, psychosocial well-being, and sexual well-being) ( P < 0.01). When examined by primary indication, all cohorts had significant preoperative to postoperative score improvement in satisfaction with breasts ( P < 0.001) and physical well-being ( P < 0.01) domains. Fifteen breasts (22%) developed postoperative complications, with implant loss in 9% of breasts. Conversion of subpectoral implants to the prepectoral plane significantly improves BREAST-Q outcomes in all aspects, including patient satisfaction with breasts and implants, as well as psychosocial, physical, and sexual well-being. Implant conversion to the prepectoral plane is becoming the authors' primary solution for most patients with chronic pain, animation deformity, or cosmetic concerns after subpectoral reconstruction. Therapeutic, IV.

176. Obese Patients Have Better Surgical Outcomes With Prepectoral Compared With Subpectoral Implant Placement

176. Obese Patients Have Better Surgical Outcomes With Prepectoral Compared With Subpectoral Implant Placement

D91. Effect of Pre-pectoral Versus Sub-pectoral Implant Placement in Breast Reconstruction on the Delivery of Post-mastectomy Radiation

PURPOSE: The placement of breast implants in a pre-pectoral compared to sub-pectoral plane has become increasingly popular in breast reconstruction, though data are limited on how this affects radiation delivery for locoregional disease control in women with breast cancer. This study aims to assess the dosimetric implications of implant location in women undergoing post-mastectomy radiation therapy (PMRT) after immediate breast reconstruction. METHODS: Patients with breast cancer treated with mastectomy, implant breast reconstruction, and PMRT between 2014-2022 at a single center were included. All patients received either intensity-modulated or 3-D conformal radiation therapy over an average of 5 weeks. Demographic, clinical and treatment data were collected through chart review. Patients were matched 1:1 on cancer sidedness, use of boost, fractionation and extent of radiation fields. Groups were compared using Mann-Whitney U or t-tests for continuous variables, and chi-square or Fisher’s Exact tests for categorical variables, as appropriate. RESULTS: Twenty-seven patients with pre-pectoral and 26 patients with sub-pectoral implants were included. Patients with pre-pectoral reconstruction had lower average implant volumes (452cc vs 503cc) prior to radiation. There was no difference in chest wall coverage (p=0.107), internal mammary node coverage (p=0.215), heart dose (p=0.627) or lung V20Gy (p=0.774). CONCLUSION: In this assessment of radiotherapeutic dosimetry in patients undergoing immediate breast reconstruction, we found no significant difference in target coverage or normal tissue dose based on pre- versus sub-pectoral implant location. This suggests that implant placement can be selected to optimize reconstructive outcomes, without concern for compromise to the oncologic quality of PMRT.

D158. Obese Patients Have Better Surgical Outcomes with Prepectoral Compared with Subpectoral Implant Placement

D158. Obese Patients Have Better Surgical Outcomes with Prepectoral Compared with Subpectoral Implant Placement

Subpectoral Implant Placement Is Not Protective against Postmastectomy Radiotherapy-Related Complications Compared to Prepectoral Placement.

Postmastectomy radiotherapy (PMRT) is associated with altered cosmetic outcomes and higher complication rates in implant-based breast reconstruction (IBR). Conventional wisdom suggests that muscle coverage is somewhat protective against PMRT-related complications. In this study, the authors compared surgical outcomes in patients who underwent two-stage prepectoral versus subpectoral IBR in the setting of PMRT. The authors performed a retrospective cohort study of patients who underwent mastectomy and PMRT with two-stage IBR from 2016 to 2019. The primary outcome was breast-related complications, including device infection; the secondary outcome was device explantation. The authors identified 179 reconstructions (101 prepectoral and 78 subpectoral) in 172 patients with a mean follow-up time of 39.7 ± 14.4 months. There were no differences between the prepectoral and subpectoral reconstructions in rates of breast-related complications (26.7% and 21.8%, respectively; P = 0.274), device infection (18.8% and 15.4%, respectively; P = 0.307), skin flap necrosis (5.0% and 1.3%, respectively; P = 0.232), or device explantation (20.8% and 14.1%, respectively; P = 0.117). In adjusted models, compared with prepectoral device placement, subpectoral device placement was not associated with a lower risk of breast-related complications [hazard ratio (HR), 0.75; 95% confidence interval (CI), 0.41 to 1.36], device infection (HR, 0.73; 95% CI, 0.35 to 1.49), or device explantation (HR, 0.58; 95% CI, 0.28 to 1.19). Device placement plane was not predictive of complication rates in IBR in the setting of PMRT. Two-stage prepectoral IBR provides safe long-term outcomes with acceptable postoperative complication rates comparable to those with subpectoral IBR, even in the setting of PMRT. Therapeutic, III.

Comparison of Outcomes Following Prepectoral and Subpectoral Implant-Based breast Reconstruction: a Systematic Review and Meta-Analysis of the Literature

Introduction: Implant-based breast reconstruction following mastectomy helps to restore the patient’s quality of life while aiming at providing optimal cosmetic outcomes. Both prepectoral (PP) and subpectoral (SP) breast implants are widely used to fulfill these objectives. It is however unclear whether one of these two options offers stronger postoperative benefits. Materials and Methods: We performed a systematic search of the English literature through PubMed, Cochrane Library and ResearchGate following the PRISMA guidelines. Postoperative pain was the primary outcome assessed. Secondary outcomes included patient’s satisfaction and postoperative complication rates such as seroma, hematoma and infection. Results: A total of nine articles involving 1802 patients were retrieved, corresponding to 502 (28%) PP and 1300 (72%) SP breast implants. The majority of articles suggested higher rates of postoperative pain following SP implants, however the heterogeneity in pain assessment did not allow us to perform a comprehensive meta-analysis regarding this outcome. The rates of seroma after surgery on the other hand were higher in PP patients and overall satisfaction as well as the rates of infection and hematoma showed no significant differences between the two cohorts. Conclusion: Our data suggest that both PP and SP implants are safe and effective methods for breast reconstruction following mastectomy although PP implants tend to provide better results in terms of postoperative pain. Yet, standardization in pain assessment would allow one to provide stronger statistical results. The risks and benefits of each procedure should be fully discussed with the patient prior to surgery and decision making should be guided by the expertise of the surgeon.

Appropriate screening mammography method for patients with breast implants

In this study, we aimed to evaluate the benefits and losses of mammography with and without implant displacement (ID) and propose an appropriate imaging protocol for the screening of breasts with implants. We evaluated mammograms of 162 breasts in 96 patients including 71 breasts with biopsy-proven cancers. Mammography of each breast included standard MLO and ID MLO images. We reviewed the mammograms using clinical image quality criteria, which consist of parameters that evaluate the proper positioning of the breast and the image resolution. Standard MLO images showed significantly higher scores for proper positioning but showed significantly lower scores for image resolution than the ID MLO images. Moreover, standard MLO images showed significantly higher kVp, mAs, and compressed breast thickness than the ID MLO images. The organ dose was also higher in the standard MLO images than in the ID MLO images, but the difference was not statistically significant. In mammography with proven cancer, ID MLO images showed significantly higher degree of cancer visibility than standard MLO images. For screening mammography in patients with breast implants, ID MLO view alone is sufficient for MLO projection with reducing the patient’s radiation dose without compromising the breast cancer detection capability, especially in dense breasts with subpectoral implants.

The Cost-Effectiveness of Prepectoral vs Subpectoral Implant Placement for Breast Reconstruction: A Markov Analysis

The Cost-Effectiveness of Prepectoral vs Subpectoral Implant Placement for Breast Reconstruction: A Markov Analysis

Comparison of Outcomes Following Prepectoral and Subpectoral Implants for Breast Reconstruction: Systematic Review and Meta-Analysis.

Simple SummaryBreast cancer is a growing problem in modern society and is one of the most prevalent cancers among women. Oncologic breast surgery has become an effective therapeutic modality but is often accompanied by major physical and moral impacts on patients. Implant-based reconstruction helps to restore quality of life and aims at providing an optimal esthetic recovery, although the question of implant placement has been too poorly assessed in the past years. In this meta-analysis, we collected and analyzed existing evidence on postoperative outcomes following prepectoral and subpectoral breast reconstruction and allowed us to provide one of the largest pools of patients on this topic. We observed globally higher pain scores following subpectoral implants; however, the rates of postoperative complications remained comparable in a pooled analysis. The risks and benefits of each procedure should be discussed with the patient prior to surgery, and decision making should be guided by surgical expertise.(1) Background: Implant-based breast reconstruction following mastectomy helps to restore quality of life while aiming at providing optimal cosmetic outcomes. Both prepectoral (PP) and subpectoral (SP) breast implants are widely used to fulfill these objectives. It is, however, unclear which approach offers stronger postoperative benefits. (2) Methods: We performed a systematic review of the literature through PubMed, Cochrane Library, and ResearchGate, following the PRISMA guidelines. Quantitative analysis for postoperative pain as the primary outcome was conducted. Secondary outcomes included patient satisfaction and postoperative complications such as seroma, implant loss, skin necrosis, wound infection, and hematoma. (3) Results: Nine articles involving 1119 patients were retrieved. Our results suggested increased postoperative pain after SP implants and significantly higher rates of seroma following PP implants (p < 0.05). Patient satisfaction was found to be similar between the two groups; however, the heterogeneity of measurement tools did not allow us to pool these results. The rates of implant loss, skin necrosis, wound infection, and hematoma showed no significant differences between the two cohorts. (4) Conclusion: Our data suggest that both implant placements are safe and effective methods for breast reconstruction following mastectomy. However, homogeneity in outcome measurements would allow one to provide stronger statistical results.

A Retrospective Study Assessing the Outcomes of Immediate Prepectoral and Subpectoral Implant and Mesh-Based Breast Reconstruction.

Simple SummaryThe aim of the study is to compare the outcomes of implant and synthetic TIGR mesh-based breast reconstructions in breast cancer patients and women, who have higher lifetime risk for breast cancer, with mutated (changed) copy of genes: BRCA1, BRCA2, PALB2 or CHEK2. This study included 170 patients after 232 mastectomies and immediate breast reconstructions. Preoperative chemotherapy was associated with more frequent minor complications, but not major ones, while postoperative chemotherapy was related to more frequent serious postoperative complications. Postoperative radiotherapy was associated with a higher rate of minor complications than no-radiotherapy. Our research found complications to be significantly associated with expander, big- volume breast, mastectomy in breast cancer patients vs risk-reducing mastectomy/prophylactic surgery in women with mutated gene and postoperative chemotherapy. Patients in whom prepectoral (prosthesis is placed above the pectoralis major muscle) surgeries were performed demonstrated shorter hospitalization time, and lower minor complication rates, but similar major complication rates. Implant-based breast reconstruction with the use of synthetic mesh is a safe and effective method of breast restoration, associated with low morbidity and good cosmesis. Nevertheless, further studies are needed to evaluate the benefits of such treatments.(1) Introduction: In response to patient concerns about breast cancer recurrence, increased use of breast magnetic resonance imaging and genetic testing, and advancements in breast reconstruction techniques, mastectomy rates have been observed to rise over the last decade. The aim of the study is to compare the outcomes of prepectoral and subpectoral implants and long-term, dual-stage resorbable mesh-based breast reconstructions in mutation carriers (prophylactic surgery) and breast cancer patients. (2) Patients and methods: This retrospective, two-center study included 170 consecutive patients after 232 procedures: Prepectoral surgery was performed in 156 cases and subpectoral was performed in 76. (3) Results: Preoperative chemotherapy was associated with more frequent minor late complications (p < 0.001), but not major ones (p = 0.101), while postoperative chemotherapy was related to more frequent serious (p = 0.005) postoperative complications. Postoperative radiotherapy was associated with a higher rate of minor complications (31.03%) than no-radiotherapy (12.21%; p < 0.001). Multivariate logistic regression found complications to be significantly associated with an expander (OR = 4.43), skin-reducing mastectomy (OR = 9.97), therapeutic mastectomy vs. risk-reducing mastectomy (OR = 4.08), and postoperative chemotherapy (OR = 12.89). Patients in whom prepectoral surgeries were performed demonstrated significantly shorter median hospitalization time (p < 0.001) and lower minor complication rates (5.77% vs. 26.32% p < 0.001), but similar major late complication rates (p = 0.915). (4) Conclusions: Implant-based breast reconstruction with the use of long-term, dual-stage resorbable, synthetic mesh is a safe and effective method of breast restoration, associated with low morbidity and good cosmesis. Nevertheless, prospective, multicenter, and long-term outcome data studies are needed to further evaluate the benefits of such treatments.

Quality of life, pain of prepectoral and subpectoral implant-based breast reconstruction with a discussion on cost: A systematic review and meta-analysis

IntroductionPrepectoral implant-based breast reconstruction (PIBR) has regained popularity, despite decades-long preference for subpectoral implant placement. This paper aims to compare patient-reported outcomes (PRO) between prepectoral and subpectoral approaches to implant-based breast reconstruction (IBBR). The primary PRO was with the BREAST-Q, and postoperative pain scores, while the secondary outcomes were complication rates. MethodsA comprehensive literature search of the PubMed library was performed. All studies on patients undergoing IBBR after mastectomy that compared prepectoral to subpectoral placement and PROM or postoperative pain were included. ResultsA total of 3789 unique studies of which 7 publications with 216 and 332 patients who received prepectoral and subpectoral implants, respectively, were included for meta-analysis.Patients with prepectoral implant placement had significantly higher satisfaction with the outcome (p = 0.03) and psychosocial well-being (p = 0.03) module scores. The pain was lower in patients with prepectoral implants on postoperative day 1 (p<0.01) and day 7 (p<0.01). The subgroup analysis of prepectoral breast implants showed that complete acellular dermal matrix coverage had lower rates of wound dehiscence (p<0.0001), but there were no significant differences in complications between one-stage and two-stage procedures. ConclusionOverall, patients with prepectoral implants reported higher BREAST-Q scores and lower postoperative pain and lower complications rates than patients with subpectoral implants. In appropriately selected patients, prepectoral implant placement with ADM coverage, be it the primary placement of an implant or placement of a tissue expander before definitive implant placement, should be the modality of choice in patients who choose IBBR. Further research should focus on patient selection, strategies to reduce cost and cost-benefit analysis of PIBR.

Prepectoral Conversion of Subpectoral Implants for Animation Deformity after Breast Reconstruction: Technique and Experience.

Background:Implant-based breast reconstruction in postmastectomy patients is commonly performed in a submuscular plane. Following reconstruction, animation deformity can be a displeasing aesthetic result for patients. In addition, patients may experience more postoperative pain with a submuscular reconstruction. Prepectoral conversion of submuscular implant position is an option for addressing these concerns. We describe a detailed technique and review our results.Methods:A retrospective review was conducted of all prepectoral conversions performed by the senior author (DSW) from 2017 to 2019 after IRB approval. All patients presented with animation deformity and another symptom such as asymmetry, pain, and/or capsular contracture. Patients underwent prepectoral conversion with smooth silicone gel implants. Demographic data, outcomes, and patient satisfaction were reviewed.Results:Prepectoral conversion was performed in 33 consecutive patients (57 breasts) with animation deformity. Twelve patients had capsular contracture, seven complained of pain, and five had ruptured implants. Postoperative complications included three infections requiring implant removal in two breasts, one implant exposure and one hematoma requiring implant replacement, five seromas requiring aspiration, and one capsular contracture. Seven patients had contour abnormalities addressed with secondary autologous fat grafting. Ultimately, all patients had elimination of animation deformity and were satisfied with the results of the conversion.Conclusions:Unsatisfactory results of subpectoral implant reconstruction such as animation deformity and chronic pain have led the reconstructive surgeon to consider various techniques to address these issues. The conversion to a prepectoral plane will effectively eliminate animation deformity, resolve pain, and yield satisfactory results in these patients.

Optimizing Symmetry after Unilateral Mastectomy and Reconstruction with a Less Form-stable Prepectoral Implant.

Summary:Implant-based breast reconstruction after bilateral mastectomy allows for excellent symmetry between the reconstructed breasts. After unilateral mastectomy, it is difficult to achieve symmetry between the reconstructed and native breast. In the past, anatomical implants provided a reconstruction that more closely resembled the shape of a native breast compared with the cohesive, round subpectoral implants commonly placed today. Here, we describe the use of a less form-stable round implant placed in the prepectoral plane after mastectomy which provides improved symmetry with the contralateral native breast.

Commentary on: Subpectoral Implant Repositioning With Partial Capsule Preservation: Treating the Long-Term Complications of Subglandular Breast Augmentation.

Commentary on: Subpectoral Implant Repositioning With Partial Capsule Preservation: Treating the Long-Term Complications of Subglandular Breast Augmentation.