One-Year Outcomes in Prepectoral versus Subpectoral Alloplastic Breast Reconstruction.

IF 3.4 2区医学 Q1 SURGERY Plastic and reconstructive surgery Pub Date : 2025-11-01 Epub Date: 2025-02-11 DOI:10.1097/PRS.0000000000012033

Perri S Vingan, Minji Kim, Lillian A Boe, Michelle R Coriddi, Robert J Allen, Joseph J Disa, Carrie S Stern, Evan Matros, Babak J Mehrara, Jonas A Nelson

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Abstract

Background: Prepectoral and subpectoral approaches to implant-based breast reconstruction (IBBR) are both reliable options after mastectomy. In this study, the authors compared 1-year complication rates, additional or revision procedures, and patient-reported outcomes between 2-stage prepectoral or subpectoral IBBR through propensity matching.

Methods: Female patients who underwent prepectoral or subpectoral 2-stage IBBR from January of 2017 to June of 2022 with BREAST-Q scores available 1 year after exchange were reviewed. Complication rates, additional or revision procedures at the time of exchange and within 1 year of exchange, and BREAST-Q scores preoperatively and at 1 year were compared between patient groups. Propensity score-matched analyses were used to reduce possible confounding or selection bias related to nonrandomized treatment assignment of patients.

Results: Of 1732 overall patients, 878 patients were included in the matched analysis (439 in each cohort). Patients with prepectoral IBBR had significantly higher rates of implant-related cellulitis or infection (5.5% versus 1.8%; P = 0.008) and implant exposure (2.3% versus 0.2%; P = 0.016) compared with patients with subpectoral IBBR, and more commonly had fat grafting at the time of the exchange procedure. On BREAST-Q, Physical Well-Being of the Chest at 1 year was significantly higher in the patients with prepectoral IBBR (median, 80 [interquartile range, 64, 92] versus 76 [64, 85]; P < 0.001). No other differences in BREAST-Q outcomes were observed.

Conclusion: In this powered analysis comparing prepectoral and subpectoral implant reconstruction at 1 year, the authors found that patients with prepectoral IBBR experienced higher rates of complications, such as infection or implant exposure, after implant exchange but had improved health-related quality of life as defined by the BREAST-Q Physical Well-Being of the Chest domain.

Clinical question/level of evidence: Therapeutic, III.

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胸前与胸下同种异体乳房重建术的1年预后。

背景：胸前入路和胸下入路植入式乳房重建术（IBBR）对于乳房切除术后的患者都是可靠的选择。在这项研究中，我们的目标是通过倾向匹配比较两期胸前或胸下IBBR的一年并发症发生率、附加/翻修手术和患者报告的结果（PROs）。方法：回顾2017年1月至2022年6月期间接受胸前或胸下两期IBBR的女性患者，并在交换后1年获得BREAST-Q评分。比较两组患者术前和术后1年的并发症发生率、手术时和1年内的附加/翻修手术以及BREAST-Q评分。使用倾向评分匹配分析来减少与患者非随机治疗分配相关的可能的混淆或选择偏差。结果：在1732例患者中，878例患者纳入匹配分析（每个队列439例）。与胸下患者相比，胸前患者的植入物相关蜂窝组织炎/感染发生率（5.5% vs. 1.8%, p=0.008）和植入物暴露率（2.3% vs. 0.2%, p=0.016）显著高于胸下患者，并且在交换手术时更常进行脂肪移植。胸前患者1年的胸部物理健康状况显著高于胸前患者(80 （IQR64,92) vs. 76(66,85)）。结论：在这项比较胸前和胸下植入物重建1年的有效分析中，我们发现胸前患者在植入物置换后出现感染或植入物暴露等并发症的比例更高，但根据BREAST-Q胸部物理健康状况定义，胸前患者的健康相关生活质量得到了改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.