Pre-Pectoral Vs. Sub-Pectoral Breast Reconstruction-a Matched-Pair Analysis of Clinical Outcomes

Abstract:

Background: The development of acellular dermal matrices (ADM) has revolutionized implant-based breast reconstruction. The most recent development has been the introduction of pre-pectoral breast reconstruction. While it is associated with decreased postoperative pain and prevention of animation deformity, concerns have been expressed related to the quality of soft tissue coverage as well as infectious complications. Hence, we felt it prudent to perform a matched-pair analysis of clinical outcomes following pre-pectoral and sub-pectoral tissue expander placement.

 

Methods: A retrospective study of patients who underwent immediate breast reconstruction by means of pre-pectoral (Group 1) and sub-pectoral (Group 2) tissue expander placement was performed. Patients in each group were matched for age, BMI, history of neoadjuvant radiotherapy, and type of ADM. Of note, patients in Group 1 received perioperative antibiotic prophylaxis for less than 24 hours while patients in Group 2 received antibiotic prophylaxis for at least 1 week.

 

Results: A total of 80 patients (138 breast reconstructions) were included in the study (Group 1: N=40; Group 2: N=40). No difference in total postoperative complication rate (p=0.356) and mastectomy skin necrosis rate (p=1.0) was noted. A trend towards a higher rate of major complications was seen in Group 2 (p=0.06). Similarly, while not statistically significant, a trend towards a higher rate of major infection (p=0.09) and loss of reconstruction (p=0.09) was noted in Group 2.

 

Conclusion: Immediate pre-pectoral tissue expander insertion with anterior ADM coverage and less than 24 hours of antibiotic prophylaxis is safe and compares favorably to sub-pectoral tissue expander placement with an inferior ADM sling and a prolonged course of antibiotics.