Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction

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Abstract
Background: There is currently no consensus on the ideal plane for implant placement in breast reconstruction. The study compares the clinical efficacy and safety between prepectoral and subpectoral implant-based breast reconstruction. Methods: PubMed, Web of Sciences, EMBASE, and Cochrane databases were systematically searched following the PRISMA guidelines. Inclusion criteria were articles describing implant-based breast reconstructions with implant placed either prepectorally or subpectorally. Primary outcomes were postoperative complications, pain score, and patients' quality of life. Results: There were 15 studies including a total of 1868 patients. Overall complication rates were comparable between the prepectoral and subpectoral groups (odds ratio [OR], 0.79; confidence interval [CI], 0.57–1.10). The capsular contracture rate was reduced in the prepectoral group (OR, 0.45; CI, 0.27–0.73), whereas no significant difference was observed in terms of skin necrosis (OR, 0.72; CI, 0.45–1.17), implant loss (OR, 0.85; CI, 0.56–1.30), and patients' quality of life (standardised mean difference, 0.25; CI, −0.51 to 1.00). Conclusion: The prepectoral implant-based breast reconstruction is a good alternative to subpectoral implant-based breast reconstruction for a certain group of patients, eliminating animation deformity without increasing complications.

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