Our Summary

This research paper is about a study comparing two types of breast reconstruction after a mastectomy (removal of one or both breasts due to cancer) - prepectoral (PBR) and subpectoral (SBR). The researchers wanted to know if one method was safer or had better outcomes for patients than the other. They looked at data from a variety of sources, including articles and studies.

In their analysis, they found that there wasn’t a significant difference in complications, such as infection, between the two methods. They also found that PBR might cause fewer issues with nipple or skin flap necrosis (death of tissue) in patients who had a certain type of implant (tissue expander) and fewer cases of capsular contracture (hardening of tissue around the implant) in those who received a different type of implant.

PBR might also result in better scores on the Breast Q (a measure of health-related quality of life in breast surgery patients) and less pain after surgery. Importantly, they also found that PBR didn’t increase the risk of the cancer coming back or spreading.

However, they caution that these results are based on limited data, and that more studies are needed to truly understand if PBR is as safe as SBR.

This research is of interest to anyone considering breast reconstruction after a mastectomy, as well as the healthcare providers involved in this process.

FAQs

  1. What is the difference between prepectoral breast reconstruction (PBR) and subpectoral breast reconstruction (SBR)?
  2. What were the main findings of the systematic review comparing PBR and SBR after mastectomies?
  3. Is prepectoral breast reconstruction as safe as subpectoral breast reconstruction according to the study?

Doctor’s Tip

A helpful tip a doctor might give a patient about breast reconstruction is to discuss with their surgeon the option of prepectoral breast reconstruction, as it may be associated with fewer complications, better patient-reported outcomes, and less postoperative pain compared to subpectoral reconstruction. It is important to have a thorough discussion with your healthcare provider to determine the best approach for your individual case.

Suitable For

Patients who have undergone mastectomies for breast cancer or other conditions are typically recommended breast reconstruction. This systematic review suggests that prepectoral breast reconstruction may be as safe as subpectoral reconstruction, with potential benefits such as fewer complications, better patient-reported outcomes, and less postoperative pain. Patients who have received tissue expanders or implants may also benefit from prepectoral reconstruction. However, more research is needed to fully understand the differences between these two approaches.

Timeline

  • Before breast reconstruction:
  1. Patient undergoes mastectomy surgery to remove breast tissue
  2. Patient may undergo tissue expansion to prepare for reconstruction
  3. Patient consults with plastic surgeon to discuss reconstruction options
  4. Patient makes decision on type of reconstruction (prepectoral or subpectoral)
  5. Patient undergoes breast reconstruction surgery
  • After breast reconstruction:
  1. Patient may experience pain and discomfort post-surgery
  2. Patient may have drains and bandages in place for a period of time
  3. Patient attends follow-up appointments to monitor healing and address any complications
  4. Patient undergoes any necessary revisions or touch-ups to achieve desired results
  5. Patient experiences improved self-esteem and quality of life following successful breast reconstruction.

What to Ask Your Doctor

  1. What are the benefits of prepectoral breast reconstruction compared to subpectoral breast reconstruction?

  2. What are the potential risks and complications associated with prepectoral breast reconstruction?

  3. How does prepectoral breast reconstruction affect the oncological safety of the mastectomy site?

  4. How does prepectoral breast reconstruction impact patient-reported outcomes, such as satisfaction with appearance and quality of life?

  5. What is the likelihood of experiencing postoperative pain with prepectoral breast reconstruction compared to subpectoral reconstruction?

  6. Are there any specific factors that would make me a better candidate for prepectoral breast reconstruction versus subpectoral reconstruction?

  7. How long is the recovery process expected to be for prepectoral breast reconstruction?

  8. What is the follow-up care and monitoring needed after undergoing prepectoral breast reconstruction?

  9. Can you provide me with information on the success rates of prepectoral breast reconstruction compared to subpectoral reconstruction?

  10. Are there any ongoing clinical trials or research studies that are investigating prepectoral breast reconstruction that I should be aware of?

Reference

Authors: Li L, Su Y, Xiu B, Huang X, Chi W, Hou J, Zhang Y, Tian J, Wang J, Wu J. Journal: Eur J Surg Oncol. 2019 Sep;45(9):1542-1550. doi: 10.1016/j.ejso.2019.05.015. Epub 2019 May 14. PMID: 31256950