Plastic Surgery Research Council

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Single Stage Direct-to-Implant Breast Reconstruction: A Comparison Between Sub-pectoral Versus Pre-pectoral Implant Placement
Trishul Kapoor, MD, Joseph Banuelos, MD, Steven Jacobson, MD, Nho V. Tran, MD, Jorys Martinez-Jorge, MD, Minh-Doan T. Nguyen, MD, PhD, Christin Harless, MD, Oscar J. Manrique, MD.
Mayo Clinic, Rochester, MN, USA.

PURPOSE: Single stage direct-to-implant (DTI) breast reconstruction can offer several potential benefits. Subpectoral DTI reconstruction can present with animation deformity and pectoralis muscle spasm. To potentially avoid these complications, surgeons have attempted pre-pectoral placement for DTI; however, the benefits of this approach are mostly unknown. We evaluated outcomes of DTI between prepectoral and subpectoral placement.
METHODS: Retrospective review of patients who underwent immediate DTI breast reconstruction (prepectoral vs subpectoral) between 2011 and 2018. Demographics, clinical characteristics, complications, and patient-reported outcomes (BREAST-Q) were compared.
RESULTS: Thirty-three patients (55-breasts) underwent prepectoral DTI and 42 patients (69-breasts) underwent subpectoral DTI. Demographics were similar among groups. Number of breasts with preoperative ptosis lower than grade II were not significantly different between groups (29.1% vs 26.1%; p=0.699). Median follow-up was 20.3 and 21 months in the prepectoral and subpectoral group, respectively. Average mastectomy weight was 300g (185-425) and 355g (203-500). Average implant size was 410cc (330-465) and 425cc (315-534) in the prepectoral and subpectoral group, respectively. Alloderm was used in all reconstructions. Total number of complications was 4 (7.2%) and 8 (11.6%) in the prepectoral and subpectoral group, respectively (p=0.227). BREAST-Q demonstrated mean patient satisfaction was high and similar among groups (75 and 74, p=0.211).
CONCLUSION: Based on these results, we believe prepectoral DTI is safe, reliable and a promising reconstructive option for selected patients, with equivalent results to other reconstructive options. Our present treatment recommendations are for patients who wish to maintain the same breast size, and have minimal or no breast ptosis.


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