Prepectoral Versus Subpectoral Breast Reconstruction in High–Body Mass Index Patients

Abstract

Background The effect of body mass index (BMI) on complication rates in prepectoral implant-based breast reconstruction is not well established. The purpose of this study was to compare complication rates between different BMI groups in subpectoral and prepectoral reconstruction. Methods A single-surgeon, 4-year, retrospective review was performed of consecutive prosthetic breast reconstructions. During this time, the senior author's practice shifted from a subpectoral to prepectoral technique. Patients were stratified into BMI subgroups (<25, 25–35, and >35 kg/m2) and complication rates were analyzed. A survey was administered to blinded medical personnel and patients comparing esthetic results. Results Implant-based reconstructions were performed in 195 patients (103 subpectoral and 92 prepectoral). No significant difference in major complication rate was observed between techniques. Among patients with BMI greater than 35 kg/m2, implant exposure occurred at a significantly higher rate in the prepectoral group (P = 0.04). In patients with BMI greater than 25 kg/m2, minor asymmetry was more prevalent with prepectoral reconstruction (12.3% vs 0%; P = 0.02). Regardless of technique, the odds of reoperation increased by 7% per point increase in BMI, although this did not reach statistical significance (P = 0.07; odds ratio, 1.07; 95% confidence interval, 0.99–1.15). A total of 66 survey responses were received. Physicians rated esthetic results more positively than patients did. Patients with a BMI of less than 25 kg/m2 were rated better than other BMI groups in nearly all categories. The position of submuscular reconstruction was rated significantly better than prepectoral. Conclusions There is a trend toward higher complication rates in prepectoral versus subpectoral breast reconstruction with increasing BMI. Nonetheless, the technique appears to be safe, with comparable clinical and cosmetic results.

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy

“…This year, the OPBC voting results stressed the need for phase III RCTs to specifically address the optimal timing of implant-based BR, the positioning of implants and the use of adjunctive mesh. Of note, multiple observational studies over the past three years on pre-versus sub-pectoral implant-based BR have predominantly shown either no difference or marginally favoured pre-pectoral positioning [ [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. However, most were small, retrospective and single-centre studies, with only a few prospective or multicentre studies [ 25 , 26 , 28 ].…”

Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction: A Systemic Review and Meta-analysis

“…Ultimately, 15 studies were included in this meta-analysis. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]…”

“…All 15 studies that reported clinical outcomes were observational studies. Eight studies were from the United States 15,16,20,22,23,[25][26][27] ; four studies from Italy 17,24,28,29 ; one study from Korea 18 ; one study from United Kingdom 19 ; and one study from Germany. 21 The sample size ranged from 63 to 642 patients.…”

“…Overall Complication All 15 studies reporting the overall complications were included in the meta-analysis. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The overall complication rates for breasts undergoing prepectoral IBBR was 25.08% (366/1459) and subpectoral IBBR was 29.65% (487/1642). As shown in (Fig.…”

“…Seroma Twelve studies in the meta-analysis reported seroma rates. [15][16][17][18][19][20][21]23,[25][26][27]29 As shown in Fig. 2b, no significant difference in seroma rates between prepectoral and subpectoral IBBR was found, with pooled (OR, 1.21; 95% CI, 0.59-2.51; P = 0.60).…”