A systematic review and meta−analysis on the prepectoral and partial subpectoral immediate single−stage Implant-Based Breast Reconstruction Using ADM

TL;DR

This study compares two breast reconstruction methods using ADMs and finds that the prepectoral approach has fewer complications.

Contribution

The study provides a meta-analysis comparing safety outcomes of prepectoral and partial subpectoral breast reconstruction techniques.

Findings

Prepectoral reconstruction significantly reduced total complication rates compared to partial subpectoral reconstruction.

Prepectoral reconstruction had lower rates of postoperative hematoma and skin–nipple necrosis.

The findings suggest prepectoral reconstruction is safer for ADM-assisted breast reconstruction.

Abstract

Acellular dermal matrices (ADMs) have made immediate single-stage prepectoral breast reconstruction (PBR) feasible and have promoted the application and development of partial subpectoral breast reconstruction (SBR). The type of mesh is regarded as a key factor influencing the safety of breast reconstruction. The optimal choice between prepectoral and partial subpectoral approaches for ADM-assisted immediate single-stage prosthetic breast reconstruction remains controversial. This study aimed to compare the safety profiles of these two surgical techniques.

A systematic literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library. All included patients underwent immediate single-stage implant-based breast reconstruction using ADM. Patient characteristics and postoperative complications were collected and summarized. Data analysis was performed using Cochrane RevMan and IBM SPSS software.

The meta-analysis incorporated 1,557 reconstructed breasts from eight eligible observational studies. Overall, PBR significantly reduced the total complication rate following immediate single-stage breast reconstruction compared with SBR. Additionally, PBR was associated with significantly lower rates of postoperative hematoma and skin–nipple necrosis compared with SBR.

The meta-analysis demonstrated that PBR was associated with lower safety risks for ADM-assisted immediate single-stage implant-based breast reconstruction.

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