LAUSR

INTRODUCTION Implant-based breast reconstruction is the most common reconstructive approach following mastectomy. Prepectoral implants offer advantages over submuscular implants, such as less animation deformity, pain, weakness, and post-radiation capsular contracture. However, clinical outcomes following prepectoral reconstruction are debated. We performed a matched cohort analysis of outcomes following prepectoral and submuscular reconstruction at a large academic medical center. METHODS Patients treated with implant-based breast reconstruction following mastectomy from January 2018 - October 2021 were retrospectively reviewed. Patients were propensity score-exact matched to control demographic, preoperative, intraoperative, and postoperative differences. Outcomes assessed included surgical site occurrences, capsular contracture, and explantation of either expander or implant. Subanalysis was done on infections and secondary reconstructions. RESULTS A total of 634 breasts were included (prepectoral: 197, submuscular: 437). 292 breasts were matched (146 prepectoral:146 submuscular) and analyzed for clinical outcomes. Prepectoral reconstructions were associated with greater rates of surgical site infection (prepectoral: 15.8%, submuscular: 3.4%, p<0.001), seroma (prepectoral: 26.0%, submuscular: 10.3%, p<0.001), and explantation (prepectoral: 23.3%, submuscular: 4.8%, p<0.001). Subanalysis of infection revealed prepectoral implants have shorter time to infection, deeper infections, more gram-negative infections, and are more often treated surgically (all p<0.05). There have been no failures of secondary reconstructions after explantation in the entire population at a mean follow up of 20.1 months. CONCLUSION Prepectoral implant-based breast reconstruction is associated with higher rates of infection, seroma, and explantation compared to submuscular reconstructions. Infections of prepectoral implants may need different antibiotic management to avoid explantation. Regardless, secondary reconstruction following explantation can readily achieve long-term success.