One-Year Outcomes in Prepectoral versus Subpectoral Alloplastic Breast Reconstruction

Background: Prepectoral and subpectoral approaches to implant-based breast reconstruction (IBBR) are both reliable options for patients following mastectomy. In this study, we aim to compare one-year complication rates, additional/revision procedures, and patient-reported outcomes (PROs) between two-stage prepectoral or subpectoral IBBR through propensity matching. Methods: Female patients who underwent prepectoral or subpectoral two-stage IBBR from January 2017 to June 2022 with BREAST-Q scores available 1 year after exchange were reviewed. Complication rates, additional/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 non-randomized treatment assignment of patients. Results: Of 1,732 overall patients, 878 patients were included in the matched analysis (439 in each cohort.) Prepectoral patients had significantly higher rates of implant-related cellulitis/infection (5.5% vs. 1.8%, p=0.008) and implant exposure (2.3% vs 0.2%, p=0.016) compared to subpectoral patients, and more commonly had fat grafting at the time of the exchange procedure. Physical Well-being of the Chest at 1-year was significantly higher in the prepectoral patients (80 (IQR64,92) vs. 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 one year, we found that prepectoral patients experience higher rates of complications such as infection or implant exposure following implant exchange but have improved health related quality of life as defined by the BREAST-Q Physical Well-being of the Chest domain.