Revision Rates In Prepectoral Versus Subpectoral Delayed-Immediate Autologous Breast Reconstruction
Ashraf A. Patel, BS1,2, Shanique A. Martin, BS2, Alan Nguyen, BS2, Rahim S. Nazerali, MD, MHS2.
1SUNY Upstate Medical University, Syracuse, NY, USA, 2Stanford University, Palo Alto, CA, USA.
Breast reconstruction in the prepectoral plane has recently fallen into favor given the reported advantages of improved pectoralis muscle preservation and lower complication incidence when compared to subpectoral reconstruction. Long-term data for prepectoral reconstruction remains limited, including insight into how rates of revisionary surgeries vary when the tissue expander is placed above the pectoralis muscle. To better understand the impact prepectoral reconstruction has on the need for breast revisionary surgery, we compared revision rates following delayed-immediate, autologous reconstruction between prepectoral and subpectoral reconstructions.
This study retrospectively reviewed postoperative charts for all patients undergoing delayed-immediate autologous breast reconstruction at our institution between June 2009 and December 2018. Demographics, comorbidities, and oncologic history was recorded. Charts were reviewed following autologous reconstruction to determine if revisions were performed. Data collected included the total number of revision surgeries as well as the number and types of procedures performed during each surgery.
A total of 74 patients were included with 103 breast reconstructions performed, 37.9% of which were prepectoral reconstructions (PP), and 62.1% were subpectoral reconstructions (SP). The rates of medical comorbidities and mastectomy types did not vary significantly between the two cohorts and neither did mean follow-up time (PP: 290.5 days vs SP: 375.0 days, p = 0.274). Fewer breasts in the prepectoral cohort required revisions (PP: 28.2% vs SP: 54.7%, p = 0.009). When comparing types of revisions (Table 1), the subpectoral cohort trended higher for scar revision (PP: 18.2% vs SP: 37.1%, p = 0.242) and more frequently required implant placement following autologous reconstruction (PP: 0% vs SP: 28.6%, p = 0.045). Scar tethering release trended higher in the prepectoral cohort (PP: 27.3% vs SP: 0%, p = 0.001).
Our study shows that patients undergoing delayed-immediate breast reconstruction in the prepectoral plane less frequently pursued breast revision surgery, as compared to reconstructions in the subpectoral plane. Specifically, breast scar revision and implant placement following autologous reconstruction trended higher in subpectoral reconstructions.
(n = 39)
(n = 64)
|Breasts Undergoing Any Revision, n (%)||11 (28.2%)||35 (54.7%)||0.009|
|Average Revisions, n ± SD||1.2 ± 0.40||1.4 ± 0.6||0.332|
|Average Procedures per Surgery||1.6 ± 0.58||1.9 ± 0.8||0.268|
|Scar Revision||2 (18.2%)||13 (37.1%)||0.242|
|Soft Tissue Rearrangement||4 (36.4%)||16 (45.7%)||0.585|
|Scar Tethering Release||3 (27.3%)||0 (0%)||0.001|
|Removal of Monitoring Skin Island||4 (36.4%)||6 (17.1%)||0.178|
|Fat Grafting||5 (45.5%)||20 (57.1%)||0.497|
|Average Volume of Fat Grafted, mL||148 ± 81.1||125 ± 59.2||0.494|
|Implant Placement||0 (0%)||10 (28.6%)||0.045|
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