Comparison of subpectoral versus dual-plane implant based immediate breast reconstruction after nipple-areola sparing mastectomy

Comparison of Postoperative Breast Asymmetry Using Vectra 3D Imaging in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction

Background/Objectives: Implant-based breast reconstruction (IBBR) is increasingly favored over autologous reconstruction due to its procedural simplicity and recovery benefits. Conducting this reconstruction using either the subpectoral or prepectoral planes has varied aesthetic outcomes. This study utilizes VECTRA XT 3D imaging to objectively assess breast symmetry differences between these surgical techniques. Methods: A retrospective cohort study was conducted analyzing data from patients undergoing unilateral total mastectomy followed by immediate silicone implant reconstruction via subpectoral or prepectoral techniques. The VECTRA XT 3D system provided measurements, including sternal-notch-to-nipple (SN-N), midline-to-nipple (ML-N), and nipple-to-inframammary fold (N-IMF) distances, as well as breast width, volume, and projection, taken more than a year postoperatively, to assess symmetry and aesthetic outcomes. Results: The study included 63 patients-29 in the subpectoral group and 38 in the prepectoral group. The SN-N ratio was 0.91 for the subpectoral group compared to 0.95 for the prepectoral group (p = 0.014). Among patients with a BMI of 25 or higher, the prepectoral group had an SN-N ratio significantly closer to 1 (0.97 ± 0.07) than the subpectoral group (0.89 ± 0.06) (p = 0.027). No statistically significant differences were found in metrics based on the surgical method across age categories divided at 50. Conclusions: The prepectoral IBBR technique shows improved nipple positioning and breast symmetry compared to subpectoral methods, as assessed via precise 3D imaging. This finding suggests potential advantages for surgical planning and patient satisfaction, indicating the need for large cohort studies to further investigate the factors influencing breast symmetry.

Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

Women undergoing implant-based reconstruction (IBR) after mastectomy for breast cancer have numerous options, including timing of IBR relative to radiation and chemotherapy, implant materials, anatomic planes, and use of human acellular dermal matrices. We conducted a systematic review to evaluate these options.

Methods

We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies, from inception to March 23, 2021, without language restriction. We assessed risk of bias and strength of evidence (SoE) using standard methods.

Results

We screened 15,936 citations. Thirty-six mostly high or moderate risk of bias studies (48,419 patients) met criteria. Timing of IBR before or after radiation may result in comparable physical, psychosocial, and sexual well-being, and satisfaction with breasts (all low SoE), and probably comparable risks of implant failure/loss or explantation (moderate SoE). No studies addressed timing relative to chemotherapy. Silicone and saline implants may result in clinically comparable satisfaction with breasts (low SoE). Whether the implant is in the prepectoral or total submuscular plane may not impact risk of infections (low SoE). Acellular dermal matrix use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections (low SoE). Risks of seroma and unplanned repeat surgeries for revision are probably comparable (moderate SoE), and risk of necrosis may be comparable with or without human acellular dermal matrices (low SoE).

Conclusions

Evidence regarding IBR options is mostly of low SoE. New high-quality research is needed, especially for timing, implant materials, and anatomic planes of implant placement.