Prepectoral Breast Reconstruction: A Safe Alternative To Submuscular Prosthetic Reconstruction Following Nipple Sparing Mastectomy.

Background: Nipple sparing mastectomy (NSM) with immediate prosthetic reconstruction is routinely performed due to excellent aesthetic results, and safe oncologic outcomes. Typically, subpectoral expanders are placed, but in select patients, this can lead to significant postoperative pain and animation deformity, due to pectoralis major muscle disinsertion and stretch. Prepectoral reconstruction is a technique that eliminates dissection of the pectoralis major, by placing the prosthesis completely above the muscle with complete acellular dermal matrix (ADM) coverage. Methods: A single surgeon's experience with immediate prosthetic reconstruction following NSM from 2012 - 2016 was reviewed. Patient demographics, adjuvant treatment, length and characteristics of the expansion, and incidence of complications during the tissue expander stage were compared, between partial submuscular/partial ADM (dual-plane) cohort and prepectoral cohort. Results: Fifty-one patients (84 breasts) underwent immediate prepectoral tissue expander placement, compared to 115 patients (186 breasts) undergoing immediate partial submuscular expander placement. The groups had similar comorbidities and postoperative radiation exposure. There was no significant difference in overall complication rate between the two groups (17.9% vs 18.8%, p = 0.49). Conclusions: Prepectoral breast reconstruction provides a safe and effective alternative to partial submuscular reconstruction, that yields comparable aesthetic results with less operative morbidity. In the authors' experience, the incidence of acute and chronic postoperative pain, and animation deformity, is significantly lower following prepectoral breast reconstruction. This technique is now considered for all patients who are safe oncologic candidates, and are undergoing NSM and prosthetic reconstruction. (C)2017American Society of Plastic Surgeons

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