Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes
Background:. Prepectoral breast reconstruction is increasingly popular. This study compares complications between 2 subpectoral and 1 prepectoral breast reconstruction technique. Methods:. Between 2008 and 2015, 294 two-staged expander breast reconstructions in 213 patients were performed with 1 of...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2017-07-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001433 |
| _version_ | 1818544241598529536 |
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| author | Lynne N. Bettinger, MD Linda M. Waters, MD, CM Stephen W. Reese, MD, MA Susan E. Kutner, MD Daniel I. Jacobs, MD |
| author_facet | Lynne N. Bettinger, MD Linda M. Waters, MD, CM Stephen W. Reese, MD, MA Susan E. Kutner, MD Daniel I. Jacobs, MD |
| author_sort | Lynne N. Bettinger, MD |
| collection | DOAJ |
| description | Background:. Prepectoral breast reconstruction is increasingly popular. This study compares complications between 2 subpectoral and 1 prepectoral breast reconstruction technique.
Methods:. Between 2008 and 2015, 294 two-staged expander breast reconstructions in 213 patients were performed with 1 of 3 surgical techniques: (1) Prepectoral, (2) subpectoral with acellular dermal matrix (ADM) sling (“Classic”), or (3) subpectoral/subserratus expander placement without ADM (“No ADM”). Demographics, comorbidities, radiation therapy, and chemotherapy were assessed for correlation with Clavien IIIb score outcomes. Follow-up was a minimum of 6 months.
Results:. Surgical cohorts (n = 165 Prepectoral; n = 77 Classic; n = 52 No ADM) had comparable demographics except Classic had more cardiac disease (P = 0.03), No ADM had higher body mass index (BMI) (P = 0.01), and the Prepectoral group had more nipple-sparing mastectomies (P < 0.001). Univariate analysis showed higher expander complications with BMI ≥ 40 (P = 0.05), stage 4 breast cancer (P = 0.01), and contralateral prophylactic mastectomy (P = 0.1), whereas implant complications were associated with prior history of radiation (P < 0.01). There was more skin necrosis (P = 0.05) and overall expander complications (P = 0.01) in the Classic cohort, whereas the No ADM group trended toward the lowest expander complications among the 3. Multivariate analysis showed no difference in overall expander complication rates between the 3 groups matching demographics, mastectomy surgery, risks, and surgical technique.
Conclusions:. Prepectoral and subpectoral Classic and No ADM breast reconstructions demonstrated comparable grade IIIb Clavien score complications. BMI > 40, stage 4 cancer, and contralateral prophylactic mastectomy were associated with adverse expander outcomes and a prior history of radiation therapy adversely impacted implant outcomes. Ninety-day follow-up for expander and implant complications may be a better National Surgical Quality Improvement Program measure. |
| first_indexed | 2024-12-11T22:45:55Z |
| format | Article |
| id | doaj.art-87426b2762bb40aba7d9bd9e0d79fbab |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-11T22:45:55Z |
| publishDate | 2017-07-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-87426b2762bb40aba7d9bd9e0d79fbab2022-12-22T00:47:37ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742017-07-015710.1097/GOX.0000000000001433gox-5-e1433Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score OutcomesLynne N. Bettinger, MD0Linda M. Waters, MD, CM1Stephen W. Reese, MD, MA2Susan E. Kutner, MD3Daniel I. Jacobs, MD4From the *Boston University Medical School, Boston, Mass.; †Department of Surgery, Stanford University Medical Center, Stanford University School Stanford University Medical Center, Stanford School of Medicine, Stanford, Calif.; ‡Department of Surgery Kaiser Permanente Medical Center San Jose, San Jose, Calif.; §Adjunct Clinical Faculty, Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, Calif.; ¶Columbia University, School of Professional Studies, Graduate Studies in Bioethics, New York, N.Y.; ‖Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.From the *Boston University Medical School, Boston, Mass.; †Department of Surgery, Stanford University Medical Center, Stanford University School Stanford University Medical Center, Stanford School of Medicine, Stanford, Calif.; ‡Department of Surgery Kaiser Permanente Medical Center San Jose, San Jose, Calif.; §Adjunct Clinical Faculty, Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, Calif.; ¶Columbia University, School of Professional Studies, Graduate Studies in Bioethics, New York, N.Y.; ‖Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.From the *Boston University Medical School, Boston, Mass.; †Department of Surgery, Stanford University Medical Center, Stanford University School Stanford University Medical Center, Stanford School of Medicine, Stanford, Calif.; ‡Department of Surgery Kaiser Permanente Medical Center San Jose, San Jose, Calif.; §Adjunct Clinical Faculty, Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, Calif.; ¶Columbia University, School of Professional Studies, Graduate Studies in Bioethics, New York, N.Y.; ‖Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.From the *Boston University Medical School, Boston, Mass.; †Department of Surgery, Stanford University Medical Center, Stanford University School Stanford University Medical Center, Stanford School of Medicine, Stanford, Calif.; ‡Department of Surgery Kaiser Permanente Medical Center San Jose, San Jose, Calif.; §Adjunct Clinical Faculty, Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, Calif.; ¶Columbia University, School of Professional Studies, Graduate Studies in Bioethics, New York, N.Y.; ‖Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.From the *Boston University Medical School, Boston, Mass.; †Department of Surgery, Stanford University Medical Center, Stanford University School Stanford University Medical Center, Stanford School of Medicine, Stanford, Calif.; ‡Department of Surgery Kaiser Permanente Medical Center San Jose, San Jose, Calif.; §Adjunct Clinical Faculty, Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, Calif.; ¶Columbia University, School of Professional Studies, Graduate Studies in Bioethics, New York, N.Y.; ‖Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.Background:. Prepectoral breast reconstruction is increasingly popular. This study compares complications between 2 subpectoral and 1 prepectoral breast reconstruction technique. Methods:. Between 2008 and 2015, 294 two-staged expander breast reconstructions in 213 patients were performed with 1 of 3 surgical techniques: (1) Prepectoral, (2) subpectoral with acellular dermal matrix (ADM) sling (“Classic”), or (3) subpectoral/subserratus expander placement without ADM (“No ADM”). Demographics, comorbidities, radiation therapy, and chemotherapy were assessed for correlation with Clavien IIIb score outcomes. Follow-up was a minimum of 6 months. Results:. Surgical cohorts (n = 165 Prepectoral; n = 77 Classic; n = 52 No ADM) had comparable demographics except Classic had more cardiac disease (P = 0.03), No ADM had higher body mass index (BMI) (P = 0.01), and the Prepectoral group had more nipple-sparing mastectomies (P < 0.001). Univariate analysis showed higher expander complications with BMI ≥ 40 (P = 0.05), stage 4 breast cancer (P = 0.01), and contralateral prophylactic mastectomy (P = 0.1), whereas implant complications were associated with prior history of radiation (P < 0.01). There was more skin necrosis (P = 0.05) and overall expander complications (P = 0.01) in the Classic cohort, whereas the No ADM group trended toward the lowest expander complications among the 3. Multivariate analysis showed no difference in overall expander complication rates between the 3 groups matching demographics, mastectomy surgery, risks, and surgical technique. Conclusions:. Prepectoral and subpectoral Classic and No ADM breast reconstructions demonstrated comparable grade IIIb Clavien score complications. BMI > 40, stage 4 cancer, and contralateral prophylactic mastectomy were associated with adverse expander outcomes and a prior history of radiation therapy adversely impacted implant outcomes. Ninety-day follow-up for expander and implant complications may be a better National Surgical Quality Improvement Program measure.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001433 |
| spellingShingle | Lynne N. Bettinger, MD Linda M. Waters, MD, CM Stephen W. Reese, MD, MA Susan E. Kutner, MD Daniel I. Jacobs, MD Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes Plastic and Reconstructive Surgery, Global Open |
| title | Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes |
| title_full | Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes |
| title_fullStr | Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes |
| title_full_unstemmed | Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes |
| title_short | Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes |
| title_sort | comparative study of prepectoral and subpectoral expander based breast reconstruction and clavien iiib score outcomes |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001433 |
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