Fewer Post-Operative Narcotics and Length of Stay in Immediate Prepectoral Breast Reconstruction
Paige L. Myers, MD1, Michael Catanzaro, MD1, Nicholas A. Wingate, MD1, Andrew W. Smith2.
1University of Rochester Medical Center, Rochester, NY, USA, 2Plastic Surgery Group of Rochester, Rochester, NY, USA.
Though placement prepectoral of breast implants dates back to the 1960s, there is a recent resurgence in popularity of this technique with due to the development of acellular dermal matrices (ADM). The benefits of prepectoral versus subpectoral placement are well described in the literature. While there are aesthetic and functional advantages, further quantification of the differences in pain and length of stay outcomes following the two procedures is lacking.The primary goal of this study is to compare the pain outcomes and use of narcotic analgesia in the immediate post-operative period in prepectoral versus subpectoral implants and how this may affect inpatient length of stay.
IRB approval was granted for a retrospective chart review of all patients who underwent immediate implant-based breast reconstruction by a single, private practice surgeon from 2013-2016. Patient age, medical comorbidities, location of tissue expander placement (prepectoral or subpectoral) and post-operative course, including length of stay (LOS), pain scores and narcotic use were recorded for analysis.
Immediate breast reconstruction with tissue expansion was performed in 208 breasts in 121 patients. Forty-six (22.1%) breast reconstructions with tissue expanders placed prepectorally were performed for 32 patients (26.4%). The average LOS between the prepectoral group was 1.56 days (95% CI 1.35 to 1.78)) and the subpectoral group was 1.94 days (95% CI 1.75 to 2.13) (p=0.031). Additonally, post-operative narcotic use in prepectoral placement was 19.81 morphine equivalents (95% CI 14.3 to 25.3) compared to subpectoral narcotic use 27.12 morphine equivalents. (95% CI 23.3 to 31)) (p=0.050). In both the prepectoral and subpectoral groups, patients with comorbidities were likely to require higher amounts of narcotics and report higher pain scores. Interestingly, though less narcotics were administered, there was no statistical difference in reported pain scores between patients with subpectoral or prepectoral tissue expander placement.
Those there are several pros and cons to each location of tissue expander placement, this study suggest that reduced pain and subsequent decrease in narcotic use may be a reason to select the prepectoral plane versus the subpectoral pain in appropriate patients Additionally, the decreased pain and nacrotic use may translate to decrease length of stay and better use of resources in an already thinly stretched health care system.
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