Implant-based techniques in breast reconstruction (IBBR) have surged in popularity, often eclipsing traditional autologous methods. The allure of IBBR lies in its relative simplicity and quicker recovery—a win-win for both surgeons and patients. However, the choice of surgical approach remains paramount, directly impacting the final aesthetic and functional results. Now, a new study published in the Journal of Clinical Medicine sheds light on this critical decision, offering a compelling head-to-head comparison of prepectoral and subpectoral IBBR using cutting-edge 3D imaging. We’ve reviewed the latest research so you don’t have to – here’s what we found.
At the Mat: Prepectoral vs. Subpectoral
The study included 63 patients who underwent unilateral mastectomy followed by immediate reconstruction using either subpectoral or prepectoral techniques. Breast symmetry was assessed more than a year post-surgery using precise 3D measurements, including sternal-notch-to-nipple (SN-N) and nipple-to-inframammary fold (N-IMF) distances, as well as breast volume and projection.
The Results Are In:
- The prepectoral technique demonstrated superior nipple positioning, with an SN-N ratio closer to 1 (0.95 vs. 0.91 in subpectoral).
- Patients with a BMI ≥ 25 exhibited enhanced symmetry with prepectoral reconstruction (SN-N ratio: 0.97 vs. 0.89).
- Other metrics, such as breast width and volume, did not differ significantly between the groups.
These findings highlight the potential of the prepectoral approach to achieve superior aesthetic outcomes, particularly in patients with a higher BMI.
Advantages of the Prepectoral Technique
The prepectoral technique is popular for good reason. One key benefit of this approach is the significant reduction of animation deformity. By leaving the pectoralis major muscle undisturbed, the technique avoids the unnatural movement or distortion of the implant that can occur with muscle contraction.
Furthermore, preserving the crucial subcutaneous tissue allows for a more realistic breast contour and projection, offering patients more natural-looking results.
And perhaps most appealing to patients is the prospect of a smoother, faster recovery. Without the need for muscle dissection, postoperative pain is minimized, and patients can return to their daily lives more quickly.
Challenges and Considerations
Despite these advantages, the prepectoral approach does present unique challenges:
- Acellular Dermal Matrix (ADM): The high cost of ADM and potential issues such as implant rippling and visibility in the superior pole remain concerns.
- Patient Selection: Patients with minimal subcutaneous tissue may be less suited for this technique due to risks of implant visibility and palpability.
Insights for Your Practice
1. Importance of BMI in Technique Selection
This study highlights BMI as a significant factor in achieving optimal outcomes with the prepectoral approach. Higher BMI patients benefit from enhanced natural tissue coverage, leading to better symmetry and nipple positioning.
2. Beyond Symmetry
While symmetry is crucial, patient satisfaction also hinges on factors like pain reduction, recovery time, and long-term implant stability. The choice between prepectoral and subpectoral techniques should balance aesthetic goals with these functional considerations.
3. The Future of Breast Reconstruction
The study advocates for larger, multicenter trials to further explore the impact of surgical techniques on breast symmetry. Incorporating predictive models using 3D imaging data could revolutionize preoperative planning, enabling more precise, patient-specific approaches.
The findings of this study affirm the advantages of the prepectoral technique in achieving better postoperative breast symmetry, particularly for patients with a higher BMI. As breast reconstruction continues to evolve, adopting evidence-based approaches and innovative technologies will be paramount in delivering optimal results. This study serves as a reminder that the marriage of art and science in aesthetic surgery thrives on continuous learning, adaptation, and a commitment to achieving the best for your patients.
SOURCES: Journal of Clinical Medicine
