LAUSR

BACKGROUND The impact of obesity on outcomes of prepectoral vs subpectoral implant based reconstruction (IBR) is not well-established. OBJECTIVES The goal of this study is to assess the surgical and patient-reported outcomes of prepectoral vs subpectoral IBR. The authors hypothesized that obese patients would have similar outcomes regardless of device plane. METHODS We conducted a retrospective review of obese patients who underwent 2-stage IBR from January 2017 to December 2019. Primary endpoint was the occurrence of any breast-related complication; secondary endpoint was device explantation. RESULTS The authors identified a total of 284 reconstructions (184 prepectoral, 100 subpectoral) in 209 patients. Subpectoral demonstrated higher rates of overall complications (50% vs 37%, p = 0.047) and device explantation (25% vs. 12.5%, p = 0.008) than prepectoral reconstruction. In multivariable regression, subpectoral reconstruction was associated with higher risk of infection (HR, 1.65; p = 0.022) and device explantation (HR, 1.97; p = 0.034). Subgroup analyses demonstrated significantly higher rates of complications and explantation in the subpectoral group in those with body mass index (BMI) ≥ 35 and BMI ≥40. The authors found no significant differences in mean scores for satisfaction with the breast (41.57 ± 13.19 vs 45.50 ± 11.91, p = 0.469), psychosocial well-being (39.43 ± 11.23 vs 39.30 ± 12.49, p = 0.914), and sexual well-being (17.17 ± 7.83 vs 17.0 ± 9.03, p = 0.931) between subpectoral and prepectoral reconstruction. CONCLUSIONS Prepectoral reconstruction was associated with significantly decreased overall complications, infections, and device explantation in obese patients compared to subpectoral reconstruction. Prepectoral reconstruction provides superior outcomes to subpectoral reconstruction with comparable patient-reported outcomes.