Clinical breast cancer · 2026
Long-Term Clinical Outcomes and Cost-Utility Analysis of Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Multicenter Retrospective Cohort Study.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Grieco Federica, Driutti Marco, Zanin Emma, Bassi Eleonora, Galvano Elena, Castriotta Luigi, Coppola Stefano Ivan, Parodi Pier Camillo, Zingaretti Nicola
Аннотация
BACKGROUND: Immediate direct-to-implant (DTI) reconstruction after nipple-sparing mastectomy (NSM) can be performed prepectorally or subpectorally, with variable use of implant-supporting mesh. We compared long-term clinical outcomes and cost-utility of 3 DTI strategies.
METHODS: Consecutive adult women undergoing NSM with immediate DTI at 2 tertiary centers in northeastern Italy (January 1, 2011-Decmeber 31, 2024) were included. Cohorts: prepectoral DTI with mesh, dual-plane subpectoral DTI with mesh, and subpectoral DTI without mesh.
PRIMARY OUTCOME: cumulative reconstruction-related reoperation.
SECONDARY OUTCOMES: early (≤ 90 days) and late (> 90 days) complications. EQ-5D-5L utilities were collected prospectively; Quality-Adjusted Life Years (QALYs) were estimated by trapezoidal integration. Hospital/provider costs were captured and standardized to 2024 €; base-case horizon 10 years with 3.5% annual discounting. Probabilistic sensitivity analysis (PSA) (10,000 iterations) quantified uncertainty.
RESULTS: Of 416 patients (501 reconstructions): prepectoral + mesh n = 215 (42.9%), subpectoral + mesh n = 144 (28.7%), subpectoral no mesh n = 142 (28.3%). Median follow-up 5.9 years. Cumulative reoperation: 13.95% (prepectoral + mesh), 27.08% (subpectoral + mesh), 21.83% (subpectoral no mesh) (P = .008). Mean observed total cost per patient: €8798.50 (prepectoral + mesh), €5235.28 (subpectoral + mesh), €3227.17 (subpectoral no mesh) (P < .001). Time-weighted mean EQ-5D-5L utilities ≈0.830 (prepectoral) versus ≈0.801 (pooled subpectoral). Ten-year discounted base-case: incremental cost ≈€4567 and incremental cost-utility ratio (ICUR) ≈€17,566/QALY for prepectoral versus pooled subpectoral. PSA: ≈68% probability prepectoral is cost-effective at €20,000/QALY.
CONCLUSIONS: Prepectoral DTI with mesh was associated with fewer late complications and reoperations and higher QALYs, at higher upfront cost; some mesh techniques showed increased early seroma/infection rates.
METHODS: Consecutive adult women undergoing NSM with immediate DTI at 2 tertiary centers in northeastern Italy (January 1, 2011-Decmeber 31, 2024) were included. Cohorts: prepectoral DTI with mesh, dual-plane subpectoral DTI with mesh, and subpectoral DTI without mesh.
PRIMARY OUTCOME: cumulative reconstruction-related reoperation.
SECONDARY OUTCOMES: early (≤ 90 days) and late (> 90 days) complications. EQ-5D-5L utilities were collected prospectively; Quality-Adjusted Life Years (QALYs) were estimated by trapezoidal integration. Hospital/provider costs were captured and standardized to 2024 €; base-case horizon 10 years with 3.5% annual discounting. Probabilistic sensitivity analysis (PSA) (10,000 iterations) quantified uncertainty.
RESULTS: Of 416 patients (501 reconstructions): prepectoral + mesh n = 215 (42.9%), subpectoral + mesh n = 144 (28.7%), subpectoral no mesh n = 142 (28.3%). Median follow-up 5.9 years. Cumulative reoperation: 13.95% (prepectoral + mesh), 27.08% (subpectoral + mesh), 21.83% (subpectoral no mesh) (P = .008). Mean observed total cost per patient: €8798.50 (prepectoral + mesh), €5235.28 (subpectoral + mesh), €3227.17 (subpectoral no mesh) (P < .001). Time-weighted mean EQ-5D-5L utilities ≈0.830 (prepectoral) versus ≈0.801 (pooled subpectoral). Ten-year discounted base-case: incremental cost ≈€4567 and incremental cost-utility ratio (ICUR) ≈€17,566/QALY for prepectoral versus pooled subpectoral. PSA: ≈68% probability prepectoral is cost-effective at €20,000/QALY.
CONCLUSIONS: Prepectoral DTI with mesh was associated with fewer late complications and reoperations and higher QALYs, at higher upfront cost; some mesh techniques showed increased early seroma/infection rates.