Direct-to-Implant Prepectoral Breast Reconstruction: Patient-Reported Outcomes

Abstract

Background: Direct-to-implant prepectoral breast reconstruction has recently experienced a resurgence in popularity because of its lower levels of postoperative pain and animation deformity. BREAST-Q, a well-validated patient-reported outcomes tool, was used to assess patient satisfaction and quality of life. The goal of this study was to assess patient-reported outcomes at 6-month and 1-year follow-up after direct-to-implant prepectoral breast reconstruction. Methods: Sixty-nine consented adult patients undergoing a total of 110 direct-to-implant, prepectoral, postmastectomy breast reconstructions completed BREAST-Q questionnaires immediately preoperatively, and at 6 and 12 months thereafter. Results: Mean breast satisfaction decreased nonsignificantly from 61.3 preoperatively to 58.6 at 12 months after reconstruction (p = 0.32). Psychosocial well-being improved nonsignificantly from 67.1 preoperatively to 71.1 at 12-month follow-up (p = 0.26). Physical well-being of the chest was insignificantly different, from 74.4 to 73.3 at 12-month follow-up (p = 0.62). Finally, sexual well-being similarly remained nonsignificantly changed from 60.2 preoperatively, to 59.1 at 12 months (p = 0.80). The use of acellular dermal matrix and postmastectomy radiotherapy did not have any significant effects on patient-reported outcomes. Through regression analysis, neoadjuvant chemotherapy, increased age, and incidence of rippling were found to negatively influence BREAST-Q results. Conclusions: Patients who underwent direct-to-implant prepectoral breast reconstruction demonstrated an overall satisfaction with their outcomes. As prepectoral breast reconstruction continues to advance and grow in popularity, patient-reported outcomes such as those presented in this study become of paramount importance in practice. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Association of Neoadjuvant Chemotherapy With Postoperative Outcomes in Immediate Prepectoral Prosthetic Breast Reconstruction

“…In the current study, complications occurred in 29.7% of patients. This result was comparable with those of previously reported studies, 1,2,14,19,20 in which the range was reported as being 5.7%–30.3% of patients. Most published studies regarding an association of postoperative complications with NACT were conducted in subpectoral cases.…”

“A Comparative Study of Wrap-Around versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction”

“…Safran et al reported that the use of ADM in DTI breast reconstruction did not have significant effects on patient-reported outcomes. 30 However, Singla et al reported their experience of DTI without ADM, which showed higher complication rates than our report, 31 and the possibility of a lot of scarring reaction cannot be excluded because the surrounding tissue can be used to stabilize the implant position without ADM. For those reasons, many surgeons have performed the prepectoral DTI breast reconstruction with the ADM.…”

Narrative review of patient-reported outcomes of breast reconstruction

“…A study of 69 patients undergoing single-stage, prepectoral direct to implant reconstruction noted no difference in BREAST-Q scores preoperatively and postoperatively at 6 and 12 months ( 41 ). A similar study showed similar BREAST-Q scores when comparing prepectoral to subpectoral direct-to-implant reconstruction in 64 patients with only sexual well-being being scored higher in the subpectoral implant cohort ( 42 ).…”