Prepectoral versus Submuscular Breast Reconstruction after Nipple-Sparing Mastectomy: Complications and Outcomes.

BACKGROUND

Preprectoral breast reconstruction and nipple-sparing mastectomy (NSM) have both risen in popularity because of advances in reconstructive techniques. However, it is unknown whether exposed lactiferous ducts in an NSM may increase the risk for infection after prepectoral implant-based breast reconstruction. The authors aimed to assess complication rates and BREAST-Q physical well-being of the chest scores in patients who underwent NSM and implant-based breast reconstruction in a prepectoral versus submuscular plane.

METHODS

A retrospective review was performed of patients who underwent NSM with 2-stage implant-based reconstruction from 2013 to 2023. Patients were grouped by prepectoral or submuscular placement. Postoperative complications and BREAST-Q scores were assessed after surgery.

RESULTS

A total of 693 patients were included: 345 underwent prepectoral and 348 underwent submuscular reconstruction. Surgical-site infection occurred in 10% of prepectoral patients and 5.7% of submuscular patients ( P = 0.03). Seroma occurred in 15% of prepectoral patients and 6.6% of submuscular patients ( P < 0.001). Multivariable analysis showed that prepectoral patients had significantly increased odds of developing surgical-site infection and seroma compared with submuscular patients (OR, 1.87; P = 0.04 and OR, 2.52; P < 0.001, respectively). However, prepectoral reconstruction was associated with significantly higher BREAST-Q physical well-being of the chest scores as compared with submuscular implant placement (β, 3.4; P = 0.01).

CONCLUSIONS

Prepectoral reconstruction following NSM is associated with higher rates of surgical-site infection and seroma but improved physical well-being of the chest compared with submuscular implant placement following NSM. An increased risk of infection and seroma should be weighed against improved patient-reported outcomes when deciding on implant plane placement after NSM.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.