INTRODUCTION: Pre-pectoral breast reconstruction is an emerging technique with potential benefits that include reduced pain, early patient recovery and no hyperanimation. There are studies reporting on clinical outcomes with pre-pectoral technique [PP] and comparing it to the dual plane technique [DP] in breast reconstruction. The goal of this study is to provide an early assessment of outcomes following PP breast reconstruction.
METHODS: A comprehensive search was performed using PubMed as well as hand-searching for literature on PP published between 01/01/2010–11/18/2016. Titles and abstracts of identified literature were reviewed against the inclusion and exclusion criteria. Studies reporting on outcomes were included for in-depth review. Patient characteristics, surgical factors and outcomes such as complication rates were extracted from each study. The extracted data were pooled and weighted averages were calculated. Patient characteristics were weighted by number of patients whereas complication rates were weighted by number of breasts. Meta-analysis was performed for studies directly comparing outcomes of PP to DP using the inverse variance weighting method. Weighted mean odds ratio, standard errors and 95% confidence intervals, taking into account study heterogeneity were calculated. Significance level was set at alpha = 0.05.
RESULTS: Ninety-five studies were identified for the initial review; 14 studies were included for in-depth review and data extraction. Of the14 studies, 7 had direct-to-implant reconstructions and the 11 studies used an acellular dermal matrix (9=ADM only; 2=mix of ADM/synthetics). The review identified 406 PP patients (n=654 breasts). Over 65% patients had prior breast operations and 53% had unilateral breast reconstruction. Eighteen and 31.6% patients had prior radiation and chemotherapy whereas 15.4% and 14.9% had post operative radiation and chemotherapy respectively. The mean follow up was 13 months (range: 6–22). The pooled complication rates were as follows: infection (4.2%), seroma (6.7%), skin necrosis (7.8%) and explantation (4.6%). Hyperanimation with pectoral muscle contraction was not observed following PP reconstruction. Four studies directly compared PP to DP (PP-135 pts [219 breasts]; DP-230 pts [408 breasts]) and were included in the meta-analysis. Early analysis of outcomes demonstrated no significant differences in complication rates between the groups.
CONCLUSION: This study summarized existing literature on PP. Early analysis demonstrates that complication rates between PP and DP may be comparable. High quality studies with longer follow up are needed to further assess outcomes associated with PP.