Skip to main content

Advertisement

SpringerLink
Log in

A systematic review and meta-analysis on the prepectoral single-stage breast reconstruction

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

The use of acellular dermal matrices (ADMs) and mesh reopened the possibility for the prepectoral single-stage breast reconstruction (PBR). The complications of single-stage breast reconstruction after PRB are controversial. We conducted a systematic review and meta-analysis of the impact of implant plane on single-stage breast reconstruction. Our aim was to evaluate the different postoperative complications between patients receiving prepectoral breast reconstruction and subpectoral breast reconstruction (SBR) on single-stage breast reconstruction.

Methods

A comprehensive research on databases including PubMed, Embase, and Cochrane libraries was performed to retrieve literature evaluating the effect of implant plane on single-stage breast reconstruction from 2010 to 2020. All included studies were evaluated the complications after single-stage breast reconstruction. Only studies comparing patients who underwent prepectoral reconstruction with a control group who underwent subpectoral reconstruction were included.

Results

A total of 13 studies were included in the meta-analysis, with a total of 1724 patients. In general, compared with SBR group, the PBR significantly reduced the risk of total complications (including seroma, hematoma, necrosis, wound dehiscence, infection, capsular contraction, implant loss/remove, and rippling) after single-stage breast reconstruction (OR: 0.54, 95% CI: 0.44–0.67, p < 0.001). Compared with the SBR group, the PBR had remarkably decreased capsular contracture (OR: 0.40, 95% CI: 0.27–0.58, p < 0.001) and postoperative infection (OR: 0.58, 95% CI: 0.36–0.95, p = 0.03).

Conclusion

The PBR is a safe single-stage breast reconstruction with fewer postoperative complications. It is an alternative surgical method for SBR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2 
Fig. 3
Fig. 4 
Fig. 5

Similar content being viewed by others

Availability of data and material

Not applicable.

Code availability

Not applicable.

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer Statistics, 2021. CA Cancer J Clin 71(1):7–33

    Article  PubMed  Google Scholar 

  2. Tripathi L, Datta SS, Agrawal SK et al (2017) Stigma perceived by women following surgery for breast cancer. Indian J Med Paediatr Oncol 38:146–152

    PubMed  PubMed Central  Google Scholar 

  3. Villa G, Mandarano R, Scirè-Calabrisotto C et al (2021) Chronic pain after breast surgery: incidence, associated factors, and impact on quality of life, an observational prospective study. Perioper Med (Lond) 10:6

    Article  Google Scholar 

  4. Sherman KA, Woon S, French J, Elder E (2017) Body image and psychological distress in nipple-sparing mastectomy: the roles of self-compassion and appearance investment. Psychooncology 26:337–345

    Article  CAS  PubMed  Google Scholar 

  5. Ahn J (2021) Suh EE [The lived experience of body alteration and body image with regard to immediate breast reconstruction among women with breast cancer]. J Korean Acad Nurs 51:245–259

    Article  PubMed  Google Scholar 

  6. Schmidt JL, Wetzel CM, Lange KW et al (2017) Patients’ experience of breast reconstruction after mastectomy and its influence on postoperative satisfaction. Arch Gynecol Obstet 296:827–834

    Article  PubMed  Google Scholar 

  7. Hart AM, Pinell-White X, Losken A (2016) The psychosexual impact of postmastectomy breast reconstruction. Ann Plast Surg 77:517–522

    Article  CAS  PubMed  Google Scholar 

  8. Reddy S, Colakoglu S, Curtis MS et al (2011) Breast cancer recurrence following postmastectomy reconstruction compared to mastectomy with no reconstruction. Ann Plast Surg 66:466–471

    Article  CAS  PubMed  Google Scholar 

  9. Snyderman RK, Guthrie RH (1971) Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg 47:565–567

    Article  CAS  PubMed  Google Scholar 

  10. Schlenker JD, Bueno RA, Ricketson G, Lynch JB (1978) Loss of silicone implants after subcutaneous mastectomy and reconstruction. Plast Reconstr Surg 62:853–861

    Article  CAS  PubMed  Google Scholar 

  11. Tasoulis MK, Iqbal FM, Cawthorn S et al (2017) Subcutaneous implant breast reconstruction: time to reconsider? Eur J Surg Oncol 43:1636–1646

    Article  PubMed  Google Scholar 

  12. Li L, Su Y, Xiu B et al (2019) Comparison of prepectoral and subpectoral breast reconstruction after mastectomies: a systematic review and meta analysis. Eur J Surg Oncol 45:1542–1550

    Article  PubMed  Google Scholar 

  13. de Haan A, Toor A, Hage JJ et al (2007) Function of the pectoralis major muscle after combined skin-sparing mastectomy and immediate reconstruction by subpectoral implantation of a prosthesis. Ann Plast Surg 59:605–610

    Article  PubMed  CAS  Google Scholar 

  14. Spear SL, Schwartz J, Dayan JH, Clemens MW (2009) Outcome assessment of breast distortion following submuscular breast augmentation. Aesthetic Plast Surg 33:44–48

    Article  PubMed  Google Scholar 

  15. Jafferbhoy S, Chandarana M, Houlihan M et al (2017) Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon. Gland Surg 6:682–688

    Article  PubMed  PubMed Central  Google Scholar 

  16. Reitsamer R, Peintinger F, Klaassen-Federspiel F, Sir A (2019) Prepectoral direct-to-implant breast reconstruction with complete ADM or synthetic mesh coverage - 36-months follow-up in 200 reconstructed breasts. Breast 48:32–37

    Article  PubMed  Google Scholar 

  17. Nahabedian MY (2018) Current Approaches to prepectoral breast reconstruction. Plast Reconstr Surg 142:871–880

    Article  CAS  PubMed  Google Scholar 

  18. Sbitany H, Piper M, Lentz R (2017) Prepectoral breast reconstruction: a safe alternative to submuscular prosthetic reconstruction following nipple-sparing mastectomy. Plast Reconstr Surg 140:432–443

    Article  CAS  PubMed  Google Scholar 

  19. Ter Louw RP, Nahabedian MY (2017) Prepectoral breast reconstruction. Plast Reconstr Surg 140:51s–59s

    Article  PubMed  CAS  Google Scholar 

  20. Chatterjee A, Nahabedian MY, Gabriel A et al (2018) Early assessment of post-surgical outcomes with pre-pectoral breast reconstruction: a literature review and meta-analysis. J Surg Oncol 117:1119–1130

    Article  PubMed  Google Scholar 

  21. Abbate O, Rosado N, Sobti N et al (2020) Meta-analysis of prepectoral implant-based breast reconstruction: guide to patient selection and current outcomes. Breast Cancer Res Treat 182:543–554

    Article  PubMed  Google Scholar 

  22. Larson KE, Braun S, Butterworth JA (2020) ASO author reflections: nipple-sparing mastectomy with prepectoral versus submuscular reconstruction: postoperative complications. Ann Surg Oncol 27:703–704

    Article  PubMed  Google Scholar 

  23. Kim JH, Hong SE (2020) A comparative analysis between subpectoral versus prepectoral single stage direct-to-implant breast reconstruction. Medicina (Kaunas) 56(10):537

    Article  Google Scholar 

  24. Ribuffo D, Berna G, De Vita R et al (2020) Dual-plane retro-pectoral versus pre-pectoral DTI breast reconstruction: an Italian multicenter experience. Aesthetic Plastic Surgery 45(1):51–60

    Article  PubMed  PubMed Central  Google Scholar 

  25. Moher D, Liberati A, Tetzlaff J, Altman D (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine 6:e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  26. Karem Slim EN, Damien Forestier, Fabrice Kwiatkowski, Yves Panis, Jacques Chipponi. 2003 Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg; 2003 Sep;73(9):712–6. .

  27. Solange Cox LB, Alex Bartholomew , Michael Sosin , Troy Pittman , Shawna Wiley ,Eleni Tousimis. Prepectoral versus retropectoral implant-based reconstruction following nipple-sparing mastectomy and adjuvant radiation therapy. Annals of Surgical Oncology 2018; 25: 231–603.

  28. Chopra K HC, Cai SS, et al. Submuscular versus prepectoral immediate implant based breast reconstruction. Northeastern Society of Plastic Surgeons Annual Meeting abstracts 2016.

  29. Kanesalingam K, Khan A, Karat I et al (2017) A retrospective study comparing early outcomes of prepectoral and subpectoral implant based breast reconstruction. European Journal of Surgical Oncology (EJSO) 43:S24–S25

    Article  Google Scholar 

  30. Baker BG, Irri R, MacCallum V et al (2018) A prospective comparison of short-term outcomes of subpectoral and prepectoral strattice-based immediate breast reconstruction. Plast Reconstr Surg 141:1077–1084

    Article  CAS  PubMed  Google Scholar 

  31. Chandarana MN, Jafferbhoy S, Marla S et al (2018) Acellular dermal matrix in implant-based immediate breast reconstructions: a comparison of prepectoral and subpectoral approach. Gland Surg 7:S64–S69

    Article  PubMed  PubMed Central  Google Scholar 

  32. Manrique OJ, Kapoor T, Banuelos J et al (2019) Single-stage direct-to-implant breast reconstruction: a comparison between subpectoral versus prepectoral implant placement. Ann Plast Surg 84:361–365

    Article  CAS  Google Scholar 

  33. Mirhaidari SJ, Azouz V, Wagner DS (2020) Prepectoral versus subpectoral direct to implant immediate breast reconstruction. Ann Plast Surg 84:263–270

    Article  CAS  PubMed  Google Scholar 

  34. Nealon KP, Weitzman RE, Sobti N et al (2020) Prepectoral direct-to-implant breast reconstruction: safety outcome endpoints and delineation of risk factors. Plast Reconstr Surg 145:898e–908e

    Article  CAS  PubMed  Google Scholar 

  35. Bernini M, Calabrese C, Cecconi L et al (2015) Subcutaneous direct-to-implant breast reconstruction: surgical, functional, and aesthetic results after long-term follow-up. Plast Reconstr Surg Glob Open 3:e574

    Article  PubMed  Google Scholar 

  36. Thangarajah F, Treeter T, Krug B et al (2019) Comparison of subpectoral versus prepectoral immediate implant reconstruction after skin- and nipple-sparing mastectomy in breast cancer patients: a retrospective hospital-based cohort study. Breast Care (Basel) 14:382–387

    Article  Google Scholar 

  37. Sobti N, Weitzman RE, Nealon KP et al (2020) Evaluation of capsular contracture following immediate prepectoral versus subpectoral direct-to-implant breast reconstruction. Sci Rep 10:1137

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Leonardis J, Lyons D, Giladi A et al (2019) Functional integrity of the shoulder joint and pectoralis major following subpectoral implant breast reconstruction. J. Orthop. Res 37:1610–1619

    Article  PubMed  Google Scholar 

  39. Wainwright DJ (1995) Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns : journal of the International Society for Burn Injuries 21:243–248

    Article  CAS  Google Scholar 

  40. Altundag K (2018) Adjuvant radiotherapy as a risk factor for developing capsular contracture in women after breast implant surgery. Journal of plastic, reconstructive & aesthetic surgery. JPRAS 71:e65

    PubMed  Google Scholar 

  41. Basu CB, Leong M, Hicks MJ (2010) Acellular cadaveric dermis decreases the inflammatory response in capsule formation in reconstructive breast surgery. Plast Reconstr Surg 126:1842–1847

    Article  CAS  PubMed  Google Scholar 

  42. Polotto S, Bergamini ML, Pedrazzi G et al (2020) One-step prepectoral breast reconstruction with porcine dermal matrix-covered implant: a protective technique improving the outcome in post-mastectomy radiation therapy setting. Gland Surg 9:219–228

    Article  PubMed  PubMed Central  Google Scholar 

  43. Graziano FD, Henderson PW, Jacobs J et al (2020) How to optimize prepectoral breast reconstruction. Aesthet Surg J 40:S22-s28

    Article  PubMed  Google Scholar 

  44. Urquia LN, Hart AM, Liu DZ, Losken A (2020) Surgical outcomes in prepectoral breast reconstruction. Plast Reconstr Surg Glob Open 8:e2744

    Article  PubMed  PubMed Central  Google Scholar 

  45. Jacob M. Marks RLF, Ahmed M. Afifi. 2020 Current trends in prepectoral breast reconstruction: a survey of American Society of Plastic Surgeons members

  46. Darrach H, Kraenzlin F, Khavanin N et al (2019) The role of fat grafting in prepectoral breast reconstruction. Gland Surg 8:61–66

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sbitany H (2017) Important considerations for performing prepectoral breast reconstruction. Plast Reconstr Surg 140:7s–13s

    Article  CAS  PubMed  Google Scholar 

  48. Becker H, Mathew PJ (2019) Immediate prepectoral breast reconstruction in suboptimal patients using an air-filled spacer. Plast Reconstr Surg Glob Open 7:e2470

    Article  PubMed  PubMed Central  Google Scholar 

  49. Maruccia M, Elia R, Gurrado A et al (2020) Skin-reducing mastectomy and pre-pectoral breast reconstruction in large ptotic breasts. Aesthetic Plast Surg 44:664–672

    Article  PubMed  Google Scholar 

  50. Khalil HH, Malahias MN, Youssif S et al (2019) Nipple-sparing mastectomy and prepectoral implant/acellular dermal matrix wrap reconstruction in large ptotic breasts. Plastic and reconstructive surgery. Global open 7:e2289

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Graduate School of Fujian Medical University, Fuzhou, 350000, Fujian Province, China

    Jiameng Liu & Xiaobin Zheng

  2. Department of Breast Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Jiameng Liu, Shunguo Lin, Hui Han & Chunsen Xu

  3. Department of Radiotherapy, Fujian Medical University Cancer Hospital, Fuzhou, 350000, Fujian Province, China

    Xiaobin Zheng

  4. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China

    Shunguo Lin, Hui Han & Chunsen Xu

  5. Breast Cancer Institute, Fujian Medical University, Fuzhou, 350001, Fujian Province, China

    Shunguo Lin, Hui Han & Chunsen Xu

Authors
  1. Jiameng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaobin Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shunguo Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hui Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chunsen Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study design: Jiameng Liu and Chunsen Xu. Literature search: Jiameng Liu and Chunsen Xu. Study selection: Jiameng Liu, Shunguo Lin, Hui Han, and Chunsen Xu. Data analysis: Jiameng Liu and Chunsen Xu. Manuscript writing: Jiameng Liu, Shunguo Lin, Hui Han, and Chunsen Xu. All authors reviewed the final manuscript and agreed to submit.

Corresponding author

Correspondence to Chunsen Xu.

Ethics declarations

Ethics approval

Ethical approval was not required for this study.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Jiameng Liu is first author.

Supplementary Information

Below is the link to the electronic supplementary material.

520_2022_6919_MOESM1_ESM.pdf

Figure. S1. Forest plot. (A) seroma, (B) hematoma, (C) necrosis, (D) wounding dehiscence, (E) implant loss/remove, (F) rippling. The diamond represents the fixed effects odds ratio and the width of the diamond corresponds to the 95% confidence interval. (PDF 1429 KB)

520_2022_6919_MOESM2_ESM.pdf

Figure. S2. Funnel plot. (A) seroma, (B) hematoma, (C) necrosis, (D) wounding dehiscence, (E) infection, (F) capsular contracture, (G) implant loss/remove, (H) rippling, (I) quality of life assessment. Vertical dashed lines represent the combined effect size and diagonal dashed lines represent the 95% confidence limit. (PDF 804 KB)

520_2022_6919_MOESM3_ESM.doc

Supplementary table1. Quality of studies assessed using the MINORS. The items are scored 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). (DOC 52 KB)

Supplementary table2. Sensitivity Analysis (DOC 34 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, J., Zheng, X., Lin, S. et al. A systematic review and meta-analysis on the prepectoral single-stage breast reconstruction. Support Care Cancer 30, 5659–5668 (2022). https://doi.org/10.1007/s00520-022-06919-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-022-06919-5

Keywords

Search

Navigation