Early Functional Outcomes After Prepectoral Breast Reconstruction

Abstract

Introduction Staged, tissue expander-based implant reconstruction continues to be the most common mode of breast reconstruction after mastectomy and has evolved significantly for the past 60 years. Prepectoral acellular dermal matrix (ADM)-assisted breast reconstruction is gaining popularity with complication rates similar to total submuscular and ADM-assisted partially submuscular reconstruction. Ours is among the first reports comparing postoperative pain and early functional outcomes between 2-stage ADM-assisted prepectoral and partial submuscular breast reconstruction. Methods Patients reconstructed with a 2-stage, ADM-assisted prepectoral approach were case matched with patients who had undergone ADM-assisted, partial submuscular reconstruction. Demographics and complication rates were compared. Primary outcomes included postoperative pain, number of days until full active shoulder range of motion was achieved, and postoperative days until drain removal. Results Forty-five breasts among 24 patients were reconstructed with ADM-assisted prepectoral tissue expanders after mastectomy and 90 breasts among 48 patients were reconstructed with ADM-assisted partial submuscular placement. There was a similarly acceptable complication profile between the 2 groups. The prepectoral group had significantly lower inpatient pain scores, required significantly less intravenous opioids and less oral opioids as outpatients. The prepectoral group saw a return to full active range of shoulder motion in half the number days of the partial submuscular group. Drain duration was similar between groups. Conclusions Prepectoral ADM-assisted breast reconstruction can be performed safely and with significantly less pain and earlier return to function than partial submuscular expander placement. Expander placement exclusively in the prepectoral pocket did not result in increased drain duration while affording patients the benefits of avoiding surgical elevation of the pectoralis muscle.

Prepectoral and Subpectoral Tissue Expander–Based Breast Reconstruction: A Propensity-Matched Analysis of 90-Day Clinical and Health-Related Quality-of-Life Outcomes

“…These data concur with recent studies showing similar pain within the first 1 to 2 postoperative weeks following subpectoral or prepectoral tissue expander placement 14,22 but differ from smaller studies that report less pain in prepectoral reconstruction patients. 19,21,25 Studies that include a mix of patients receiving both direct-to-implant and tissue expander…”

Prepectoral breast reconstruction

“…Schaeffer et al reported early functional outcomes following prepectoral breast reconstruction in comparison with subpectoral breast reconstruction [33]. They showed that the prepectoral groups had significantly lower inpatient pain scores.…”

Understanding the Evidence and Improving Outcomes with Implant-Based Prepectoral Breast Reconstruction

“…51,52 Two studies evaluated upper extremity and shoulder function, with more rapid recovery and less upper extremity morbidity than partially submuscular patients. 43,52 One patient series demonstrated fewer morphine equivalents administered after prepectoral reconstruction than in a partially submuscular implant placement cohort. 43 Fewer postoperative visits and more rapid expansion have been demonstrated with prepectoral breast reconstruction when compared with subpectoral techniques, which can improve patient satisfaction with recovery.…”

“…Meshing and fenestrating the acellular dermal matrix to increase its functional surface area 26 while stabilizing cost have been described, as has orienting mesh differently based on breast base width. 43 Meshing or fenestrating acellular dermal matrices would create potential space for native capsule formation that may increase capsular Copyright © 2021 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.…”