LAUSR

BACKGROUND Implant-based breast reconstruction remains the most commonly used method following mastectomy, but data is lacking regarding differences in complications and long-term patient-reported outcomes for two-stage sub-pectoral versus pre-pectoral reconstruction. We sought to better understand the risks and impact of these reconstructive approaches on overall satisfaction. METHODS Patients who underwent unilateral or bilateral nipple-sparing mastectomy and two-stage implant-based reconstruction from 2014 to 2019 were identified from the electronic medical records and contacted via email to complete the BREAST-Q survey. Overall satisfaction was measured by the question, "How happy are you with the outcome of your breast reconstruction?" using a six-point Likert scale. Patients were grouped into sub-pectoral or pre-pectoral cohorts. Complications were evaluated retrospectively. Only patients who were at least six months from their final reconstruction were included in the analysis. RESULTS Of the 582 patients contacted, 206 (35%) responded. The sub-pectoral (n = 114) and pre-pectoral (n=38) groups did not differ significantly by demographic or treatment characteristics. BREAST-Q scores were also comparable. Complication rates were similar, but pre-pectoral patients had a significantly higher rate of capsular contracture (16% vs 4%, p < 0.05). Bivariate ordered logistic regression identified pre-pectoral implant placement, having any post-operative complication, and capsular contracture as predictors of less overall happiness. CONCLUSION Our study suggests that pre-pectoral patients may have slightly higher complication rates but are as satisfied as sub-pectoral patients after at least a year of follow-up. Further studies should investigate risk factors for capsular contracture, how the risk changes over time, and how it impacts patient satisfaction.