A 10-Year Retrospective Analysis of Clinical Outcomes After Prepectoral Implant-Based Breast Reconstruction Performed by a Single Surgeon
Catherine J. Sinnott, MD1, Mary T. Pronovost, MD2, Christine Hodyl, DO3, Melanie Lynch, MD4, Freya Young, BS1, Sanford Edwards, MD3, Anke Ott Young MD, PhD1
1Yale New Haven Health/Bridgeport Hospital; Bridgeport, CT, 2Lewis Katz School of Medicine at Temple University; Philadelphia, PA, 3Mount Sinai South Nassau; Oceanside, NY, 4Yale School of Medicine, New Haven, CT
Background: Prepectoral implant breast reconstruction is a reconstructive option offered to an increasing number of breast cancer patients. This minimally invasive procedure results in less postoperative pain, faster recovery and a lower risk of animation deformity compared to subpectoral reconstruction. Despite these advantages, broad acceptance of the procedure is still slow secondary to safety concerns, including a fear of an increased risk of capsular contracture, implant exposure and implant visibility, as well as delayed detection of breast cancer recurrence. The purpose of this study was to describe clinical outcomes in prepectoral breast reconstruction performed by a single surgeon over a 10-year period.
Methods: A retrospective chart review was performed of all patients who underwent prepectoral implant breast reconstruction from 2010 to 2020. Demographic, clinical and operative data were reviewed and recorded. Outcomes were assessed by evaluating complication rates including, capsular contracture, infection, mastectomy skin flap necrosis, implant loss, seroma, hematoma, dehiscence and local recurrence.
Results: 758 prepectoral implant breast reconstructions were performed in 468 patients with a mean age of 52.5 +/- 9.9 (+/- SD) years and mean body mass index (BMI) of 28.8 +/- 6.1 kg/m2. 27 patients (5.8%) were active smokers, 24 patients (5.1%) were diabetic and 107 breasts (14.1%) received postmastectomy radiation therapy. Complications rates compared favorably to published outcome data in subpectoral reconstruction, with regard to capsular contracture (6.5%), major infection (3.4%), major mastectomy skin flap necrosis (1.7%), implant loss (4.1%), seroma (0.3%), hematoma (0.3%), dehiscence (0.7%) and local recurrence (1.3%).
Conclusions: The results of this large cohort study of prepectoral implant reconstruction performed over a decade, show that this minimally invasive method of direct-to-implant reconstruction is associated with a low complication rate and favorable safety profile. Complication rates in this study were comparable to published data on subpectoral reconstruction and rates of capsular contracture, implant exposure and local recurrence were not increased with prepectoral reconstruction. Prepectoral implant breast reconstruction should be offered to breast cancer patients in settings where there is an experienced team of oncoplastic surgeons because of the reduced invasiveness of the procedure, postoperative pain and low complication rates.
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