Comparison Between Prepectoral and Subpectoral Direct-to-Implant Breast Reconstruction: a Case Series Analysis

Implant-based reconstruction is currently the most common postmastectomy breast reconstruction modality. The one-stage subpectoral approach is widely performed but entails many complications. Prepectoral direct-to-implant (DTI) reconstruction resolves many of these issues. Currently, only a relatively small number of studies have compared the outcomes of these two approaches. The aim of this study is to evaluate and compare the outcomes of prepectoral and subpectoral direct-to-implant immediate breast reconstruction. Data was obtained from all patients between November 2017 and January 2020 from accrual patient records. They were organized into one of two cohorts, prepectoral and subpectoral reconstruction, according to surgeon's assessment of the postmastectomy flap viability. A total of 113 women (150 breasts) underwent direct-to-implant reconstruction by a single plastic surgeon (Y.G), with 82 patients (72.6%) in the prepectoral cohort. In the prepectoral group, the mean postoperative day of drain removal was 13.59 (SD=5.43) days, while in the subpectoral group, it was a mean of 16.13 (SD=5.75) (p=0.016). The total mean number of days when postoperative narcotics were administered was 2.61 (SD=2.93) in the prepectoral cohort and 5.16 (SD=4.57) in the subpectoral cohort (p=0.003). There were no statistically significant differences regarding major or minor complications between the groups. A wrapping technique analysis in the prepectoral cohort shows no complications in the oblique subgroup. This study demonstrates that prepectoral direct-to-implant reconstruction is a safe modality with a lower usage of postoperative narcotics and a shorter period until drainage removal.