Arch Aesthetic Plast Surg.  2022 Oct;28(4):119-125. 10.14730/aaps.2022.00570.

A prospective comparison of prepectoral and subpectoral methods for immediate breast reconstruction with acellular dermal matrix: the cogwheel-shaped anterior wrapping method

• Kim SE
• Chun YS
• Park HK
• Kim YJ
• Cheon YW

• KMID: 2535746
• DOI: http://doi.org/10.14730/aaps.2022.00570

Abstract

Background
Prepectoral breast reconstruction has recently gained wide recognition for its advantages, such as rapid recovery and less pain. This study compared the effectiveness of and differences between the prepectoral and subpectoral breast reconstruction techniques.
Methods
Eighty-three patients (90 breasts) who underwent prepectoral or subpectoral breast reconstruction surgery between January 2019 and December 2020 were prospectively recruited. Patient demographics, comorbidities, oncological treatment, and intraoperative and postoperative data were evaluated to investigate the validity and stability of each surgical technique. The follow-up period was a minimum of 18 months.
Results
The surgical cohorts (22 prepectoral and 68 subpectoral) had comparable demographics. No significant differences in postoperative complications were observed between the two groups. The prepectoral group showed shorter operation times than the subpectoral group (mean: 97.27 and 127.63 minutes, respectively; P<0.001). Fewer days elapsed until drain removal and the total amount of drainage was less in the prepectoral group than in the subpectoral group (mean: postoperative day [POD] 8.95 and 10.06, respectively; P=0.048) and (501.72 mL and 671.19 mL, respectively; P=0.009). The numeric pain rating scale (NPRS) scores at POD 7 were significantly lower in the prepectoral group than in the subpectoral group (mean: 0.41 and 1.82, respectively; P=0.029). There were no statistically significant differences in the NPRS scores at POD 1 or the BREAST-Q questionnaire scores at 3 months.
Conclusions
Prepectoral breast reconstruction using acellular dermal matrix can feasibly replace the conventional subpectoral breast reconstruction technique and has the advantages of reducing operation time, length of hospitalization, and long-term postoperative pain.

Keyword

Breast implantation; Acellular dermis; Prospective studies; Treatment outcome; Patient reported outcome measures