Breast implants can be placed in front of the muscle or behind it. You will find plastic surgeons on both sides of this fence. But is there a difference in outcome? Are complications different?
This was a published study in Feb 2024 Plastic Surgery and Reconstructive Journal. “Prepoectoral versus Submuscular Implant Based Breast Reconstruction: A Matched Pair Comparison of Outcomes.”
I don’t do a lot of breast cancer reconstruction. But a study like this- matched pair comparison of outcomes- is applicable to breast augmentation as well. So what did they find?
Study:
- Implant based mastectomy breast reconstruction. Prepectoral 197; Submuscular 437- they then matched them to get equal numbers of 146 of each with matched preoperative, demographics, surgery, and postoperatively.
- They looked at outcomes
PREPECTORAL:
- Higher surgical site infection (15.8% vs 3.4%)
- Seroma (26% vs 10.3%)
- Explantation – a need to remove the implant (23.3% vs 1.8%)
- When looking at infections there was a shorter time to infection, deeper infections, and more gram negative infections.
- Gram negative infections are more often needed to be treated surgically
They conclude that an infection in prepectoral infections need to be treated earlier and more aggressively with antibiotics to cover gram negatives.
My thoughts?
This was a good head to head study. It makes sense- putting the breast implant under the skin doesn’t offer it as many layers of protection from the outside world. Any issue with the healing, bacteria can access the implant. Once that happens, biofilm establishes. Infection of the foreign object cannot be cleared by oral or IV antibiotics, so it must be removed- hence the explant.
The study did not discuss some of the newer trends in breast cancer reconstruction- trying to leave thicker skin flaps, consistent use of of dermal matrixes to “wrap” the implant to protect it.
But a good study, and something to consider when doing breast implant placement- for breast cancer reconstruction or for breast augmentation.