Expediting Tissue Expansion in Implant Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement
Blair A. Wormer, MD1, Al C. Valmadrid, BS1, Nishant Ganesh Kumar, MD2, Salam Al Kassis, MD1, Timothy M. Rankin, MD1, Kent K. Higdon, MD1.
1Vanderbilt University Medical Center, Nashville, TN, USA, 2University of Michigan Health System, Ann Arbor, MI, USA.
PURPOSE: A disadvantage of expander-based breast reconstruction (EBBR) that impacts patients and healthcare costs is the numerous visits required for expansion. This study aimed to determine if prepectoral EBBR offers expedited tissue expansion compared to subpectoral EBBR without affecting complication rates.
METHODS: Consecutive patients who had undergone immediate EBBR from January 2016 to July 2017 by a single-surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral EBBR and reviewed. The primary outcomes were total days and number of visits to expansion completion. Groups were compared by univariate analysis with significance set at p<0.05.
RESULTS: In total, 101 patients (subpectoral=69, prepectoral=32) underwent 184 EBBR (subpectoral=124, prepectoral=60). There was no difference in age, body mass index, smoking or diabetes between the groups (all p>0.05). Between prepectoral and subpectoral patients there was similar postoperative total morphine equivalents (22.6±18.5 vs. 30.4±19.6;p=0.062). Prepectoral patients took fewer days to complete expansion(40.4±37.8days vs. 62.5±50.2days;p=0.032), fewer office visits to complete expansion(2.3±1.7 vs. 3.9±1.8;p<0.001), and were expanded to greater final volumes than subpectoral patients(543.7±122.9ml vs. 477.5±159.6ml;p=0.046). Between prepectoral and subpectoral there were similar rates of minor complications(25% vs. 18.5%;p=0.311), readmission(5% vs. 2.4%;p=0.393), seroma(8.3% vs. 5.6%;p=0.489), reoperation for hematoma(3.3% vs. 1.6%;p=0.597), explantation(5% vs. 2.4%;p=0.393), and length of follow up(179.3±98.2days vs. 218.3±119.8days;p=0.111).
CONCLUSION: This study demonstrates that prepectoral EBBR facilitates decreased time and number of visits to complete expansion compared to subpectoral EBBR, without increasing complication rates. These benefits of prepectoral EBBR may have downstream effects on improved patient satisfaction and healthcare costs, which merits further prospective study.
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