Early assessment of post-surgical outcomes with pre-pectoral breast reconstruction: A literature review and meta-analysis

Abstract

Background: Pre-pectoral breast reconstruction is an emerging surgical approach. This study provides an early assessment of outcomes with the technique. Methods: A comprehensive literature review was performed through searches of PubMed®/MEDLINE® to identify studies on pre-pectoral reconstruction. Patient characteristics and outcomes were extracted from studies and pooled. Linear relationships between complication rates and patient characteristics with pre-pectoral reconstruction were analyzed. A meta-analysis compared complication rates between pre-pectoral and dual-plane reconstruction. Results: Fourteen studies (406 women/654 breasts) were included. The most common complications with pre-pectoral reconstruction were flap necrosis (7.8%), seroma (6.7%), capsular contracture (5.8%), and explantation (4.6%). No hyperanimation was reported. Significant correlation between previous radiation and flap necrosis, post-operative chemotherapy and infection, hypertension and flap necrosis, diabetes and dehiscence, and smoking and explantation were found. A meta-analysis of four studies comparing pre-pectoral (135 women/219 breasts) and dual-plane (230/408) reconstruction found no significant difference for likelihood of infection (odds ratio, 0.46; 95% confidence interval, 0.16-1.30), explantation (0.83; 0.29-2.38), necrosis (1.61; 0.77-3.36), seroma (1.88; 0.71-5.02), dehiscence (1.84; 0.68-4.95), or capsular contracture (0.14; 0.02-1.14). Conclusions: Complication rates are comparable following pre-pectoral and dual-plane reconstruction, indicating the pre-pectoral technique may be a feasible option for appropriate patients.