Immediate Hybrid Breast Reconstruction: Dual-plane approach using prepectoral implants and retro-pectoral fat grafting

Background: Implant-based breast reconstruction (BR) is to date the most popular reconstructive modality. The aim of the study was to evaluate the immediate hybrid one-stage BR technique, with a dual-plane approach, using prepectoral implants and retro-pectoral autologous fat transfer (AFT). Methods: We prospectively enrolled patients scheduled for immediate BR using a hybrid approach, which included retro-pectoral AFT and prepectoral breast implants (Group-A). This cohort was compared with a retrospective control group of patients who underwent immediate direct-to-implant BR without AFT (Group-B). Complications, hospitalization days, number of AFT procedures for a complete BR, aesthetic outcomes and patient’s satisfaction were analysed. Fat survival rate was assessed through comparison of preoperative and 6-months postoperative MRI. Results: 30 immediate BR were included in each group. The average amount of AFT in the retro-pectoral plane was 106.30 cc (SD 16.54), while the mean breast implant size was statistically higher in group B (p=0.00026). MRI assessment confirmed an average of 47.90 % (SD 0.14) retro-pectoral fat survival at 6 postoperative months. No statistically significant differences in term of complications and hospitalization days were observed (p>0.05), while a significant difference was observed regarding additional AFT sessions (p=0.00062). After a propensity score weighted analysis, surgeons and patients assessment showed a significant higher overall satisfaction in the active group. Conclusions: Immediate hybrid approach for one-stage BR, enabled the use of smaller breast implants, a decrease in AFT procedures with costs reduction, and yielded optimal breast shape and contour, by reducing step-off deformity and rippling alterations, without adding complications. Level of Evidence II