Meta-analysis of prepectoral implant-based breast reconstruction: guide to patient selection and current outcomes

Abbate, Olivia; Rosado, Nikki; Sobti, Nikhil; Vieira, Brittany L.; Liao, Eric C.

doi:10.1007/s10549-020-05722-2

Cited by 35 publications

(30 citation statements)

References 51 publications

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“…Different factors must be considered when choosing pre-pectoral placement, chief among them are the mastectomy skin flap thickness and viability 22 , 29 . As surgical oncologists more consistently preserve vascularity of mastectomy skin flaps, pre-pectoral placement of implants or tissue expanders has been increasingly utilized to restore breast form following mastectomy at many high-volume centers 19 , 29 – 34 . Recent retrospective studies and meta-analyses have found pre-pectoral reconstruction to demonstrate a favorable or comparable safety profile when compared to sub-pectoral reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…Recent retrospective studies and meta-analyses have found pre-pectoral reconstruction to demonstrate a favorable or comparable safety profile when compared to sub-pectoral reconstruction. In fact, pre-pectoral reconstruction often demonstrates lower rates of capsular contracture and skin flap necrosis 19 , 23 , 25 , 35 – 38 . However, pre-pectoral breast reconstruction also has limitations.…”

Section: Introductionmentioning

confidence: 99%

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Cost analysis of pre-pectoral implant-based breast reconstruction

Chinta

Koh

Sobti

et al. 2022

Sci Rep

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With improvement in mastectomy skin flap viability and increasing recognition of animation deformity following sub-pectoral implant placement, there has been a transition toward pre-pectoral breast reconstruction. While studies have explored the cost effectiveness of implant-based breast reconstruction, few investigations have evaluated cost with respect to pre-pectoral versus sub-pectoral breast reconstruction. A retrospective review of 548 patients who underwent mastectomy and implant-based breast reconstruction was performed from 2017 to 2020. The demographic and surgical characteristics of the pre-pectoral and sub-pectoral cohorts were well matched, except for reconstructive staging, as patients who underwent pre-pectoral reconstruction were more likely to undergo single-stage instead of two-stage reconstruction. Comparison of institutional cost ratios by reconstructive technique revealed that the sub-pectoral approach was more costly (1.70 ± 0.44 vs 1.58 ± 0.31, p < 0.01). However, further stratification by laterality and reconstructive staging failed to demonstrate difference in cost by reconstructive technique. These results were confirmed by multivariable linear regression, which did not reveal reconstructive technique to be an independent variable for cost. This study suggests that pre-pectoral breast reconstruction is a cost-effective alternative to sub-pectoral breast reconstruction and may confer cost benefit, as it is more strongly associated with direct-to-implant breast reconstruction.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost analysis of pre-pectoral implant-based breast reconstruction

Chinta

Koh

Sobti

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Abbate et al [37] recently showed that rippling of the skin over the implant especially in the superior pole was the most frequently observed postoperative complication, followed by seroma and mastectomy skin flap necrosis in the prepectoral plane breast reconstruction setting. In their analysis, patients receiving prepectoral reconstruction were more likely to undergo direct-to-implant reconstruction than tissue expander placement, demonstrating a statistically significant decrease in chances of skin flap necrosis and capsular contracture in the prepectoral setting compared to the subpectoral one.…”

Section: Autologous Versus Alloplastic Breast Reconstruction (Prepectoral Vs Subpectoral Approach) – Complicationsmentioning

confidence: 99%

Breast Reconstruction: Necessity for Further Standardization of the Current Surgical Techniques Attempting to Facilitate Scientific Evaluation and Select Tailored Individualized Procedures Optimizing Patient Satisfaction

Tampaki

Tampakis

2021

Breast Care

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Background: Various breast cancer reconstruction methods and novel surgical techniques include autologous or allogenic procedures, which can increase patient’s quality of life and provide options when dealing with patients seen as challenging clinical scenarios. Summary: Our aim was to review the current literature and present published evidence on innovative standards in whole breast reconstruction. Advances in flap monitoring or newly published data regarding neurotization in breast reconstruction, arm lymphedema management, breast implant-associated anaplastic large cell lymphoma reconstruction treatment, and robotic surgery with regard to radiotherapy define innovative standards in the breast reconstruction setting. The role of meshes/acellular dermal matrix and fat grafting as well as optimal sequencing of postmastectomy radiotherapy in autologous and alloplastic breast reconstruction appear highly debatable also in expert panel meetings rendering further clinical research including RCTs imperative. Key Messages: There is an abundance of novel available techniques, which mandate further standardization, facilitating scientific evaluation in an attempt to help surgeons select tailored procedures for each patient with the goal to promote informed decision-making in breast reconstruction.

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“…In the meta-analysis of Li et al [41], the risk of implant loss after prepectoral and subpectoral reconstructions without radiotherapy was 4.2% and 4.5% respectively. In the meta-analysis of Abbate et al [42], about 80% of 4040 patients were not irradiated. It was found that there were statistically significant differences concerning the rate of skin necrosis (3.3% vs. 5.9%, p < 0.01) and fibrosis of the skin around the implant (4.2% vs. 7.6%, p < 0.01) which worked to the advantage of prepectoral reconstruction.…”

Section: Comparison Of Alloplastic Prepectoral Breast Reconstructions...mentioning

confidence: 99%

The risk of reconstruction failure following a mastectomy, breast reconstruction and radiotherapy depending on the reconstruction technique

Niwińska

2021

Nowotwory. Journal of Oncology

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Improvements in the recently observed breast reconstruction surgery techniques have changed the clinical practice in patients with breast cancer. Nowadays, every patient diagnosed with breast cancer clinical stage I, II and III, except for inflammatory breast cancer, should have the opportunity to undergo breast reconstruction. Radiation therapy increases the risk of complications following reconstruction. The aim of this paper is to review the current literature in an attempt to select the safest and most convenient reconstruction technique in patients requiring radiation therapy. Immediate autologous breast reconstruction seems to be the best option, but everyday clinical practice seems to contradict the conclusions from these data. The choice of the reconstruction type depends not only on the rate of complications but on the surgeon's skills, the patient's preference and the hospital's equipment.

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Meta-analysis of prepectoral implant-based breast reconstruction: guide to patient selection and current outcomes

Cited by 35 publications

References 51 publications

Cost analysis of pre-pectoral implant-based breast reconstruction

Cost analysis of pre-pectoral implant-based breast reconstruction

Breast Reconstruction: Necessity for Further Standardization of the Current Surgical Techniques Attempting to Facilitate Scientific Evaluation and Select Tailored Individualized Procedures Optimizing Patient Satisfaction

The risk of reconstruction failure following a mastectomy, breast reconstruction and radiotherapy depending on the reconstruction technique

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