Acute Postoperative Complications in Prepectoral versus Subpectoral Reconstruction following Nipple-Sparing Mastectomy.

MedStar author(s):
Citation: Plastic & Reconstructive Surgery. 146(6):715e-720e, 2020 12.PMID: 33234947Institution: MedStar Washington Hospital CenterDepartment: Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Breast Implantation/ae [Adverse Effects] | *Breast Neoplasms/su [Surgery] | *Mastectomy, Subcutaneous/ae [Adverse Effects] | *Postoperative Complications/ep [Epidemiology] | Adult | Breast Implantation/is [Instrumentation] | Breast Implants/ae [Adverse Effects] | Female | Humans | Mastectomy, Subcutaneous/mt [Methods] | Middle Aged | Necrosis/ep [Epidemiology] | Necrosis/et [Etiology] | Necrosis/pa [Pathology] | Nipples/pa [Pathology] | Nipples/su [Surgery] | Pectoralis Muscles/su [Surgery] | Postoperative Complications/et [Etiology] | Postoperative Complications/pa [Pathology] | Retrospective Studies | Surgical Flaps/pa [Pathology] | Surgical Flaps/tr [Transplantation]Year: 2020ISSN:
  • 0032-1052
Name of journal: Plastic and reconstructive surgeryAbstract: BACKGROUND: Nipple-sparing mastectomy is associated with improved aesthetics and oncologic safety. Recently, there has been a resurgence in prepectoral reconstruction. Because of limited data comparing complication rates on patients undergoing prepectoral breast reconstruction, this study compared 30-day postoperative complications by plane of prosthetic placement.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.CONCLUSIONS: Prepectoral reconstruction is associated with similar overall 30-day postoperative complications and reoperations compared to traditional subpectoral implants. However, prepectoral reconstruction was associated with significantly decreased ischemic complications, including mastectomy flap necrosis and nipple-areola complex loss because of necrosis.METHODS: A retrospective review was conducted on all consecutive patients undergoing nipple-sparing mastectomy with implant-based reconstruction with either prepectoral or subpectoral placement from 2014 to 2018. The primary outcome was a composite, acute 30-day postoperative complication, including nipple-areola complex necrosis, mastectomy flap necrosis, wound dehiscence, infection, hematoma, and seroma. Secondary outcomes included nipple loss and rates of unintended reoperations. Univariate and mixed effects multivariate logistic regression were used to compare outcomes.RESULTS: A total of 228 patients and 405 breasts were included in the final cohort, with 202 in the subpectoral cohort and 203 in the prepectoral cohort. The overall complication rate was 7.65 percent, with no significant difference between subpectoral and prepectoral cohorts (9.41 percent versus 5.91 percent, respectively; p = 0.148). Prepectoral reconstruction was associated with significantly reduced ischemic complications, including nipple loss because of necrosis (2.97 percent versus 0.49 percent, respectively; p = 0.015) and mastectomy flap necrosis (5.45 percent versus 0 percent; p = 0.003). There were no significant differences in rates of infection, hematoma, seroma, or implant loss/exchange.All authors: Avila A, Bartholomew AJ, Deldar R, Fan KL, Griffith KF, Song DH, Sosin M, Tousimis EA, Willey SCFiscal year: FY2021Digital Object Identifier: Date added to catalog: 2021-04-01
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Journal Article MedStar Authors Catalog Article 33234947 Available 33234947

BACKGROUND: Nipple-sparing mastectomy is associated with improved aesthetics and oncologic safety. Recently, there has been a resurgence in prepectoral reconstruction. Because of limited data comparing complication rates on patients undergoing prepectoral breast reconstruction, this study compared 30-day postoperative complications by plane of prosthetic placement.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

CONCLUSIONS: Prepectoral reconstruction is associated with similar overall 30-day postoperative complications and reoperations compared to traditional subpectoral implants. However, prepectoral reconstruction was associated with significantly decreased ischemic complications, including mastectomy flap necrosis and nipple-areola complex loss because of necrosis.

METHODS: A retrospective review was conducted on all consecutive patients undergoing nipple-sparing mastectomy with implant-based reconstruction with either prepectoral or subpectoral placement from 2014 to 2018. The primary outcome was a composite, acute 30-day postoperative complication, including nipple-areola complex necrosis, mastectomy flap necrosis, wound dehiscence, infection, hematoma, and seroma. Secondary outcomes included nipple loss and rates of unintended reoperations. Univariate and mixed effects multivariate logistic regression were used to compare outcomes.

RESULTS: A total of 228 patients and 405 breasts were included in the final cohort, with 202 in the subpectoral cohort and 203 in the prepectoral cohort. The overall complication rate was 7.65 percent, with no significant difference between subpectoral and prepectoral cohorts (9.41 percent versus 5.91 percent, respectively; p = 0.148). Prepectoral reconstruction was associated with significantly reduced ischemic complications, including nipple loss because of necrosis (2.97 percent versus 0.49 percent, respectively; p = 0.015) and mastectomy flap necrosis (5.45 percent versus 0 percent; p = 0.003). There were no significant differences in rates of infection, hematoma, seroma, or implant loss/exchange.

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