Decreased Postoperative Pain and Opioid Use following Prepectoral versus Subpectoral Breast Reconstruction after Mastectomy: A Retrospective Cohort Study: Pain after pre versus subpectoral reconstruction

SUMMARY Background Prepectoral (PP) breast reconstruction is now commonly performed and minimizes dissection of the pectoralis major muscle. Data are lacking comparing the immediate postoperative recovery of these patients as compared to traditional subpectoral (SP) breast reconstruction. Methods From December 2015 to February 2017, 73 patients underwent PP prosthetic-based reconstruction at a single academic institution. PP cases were matched 1:1, by age and stage, to patients undergoing traditional SP reconstruction. Analysis of postoperative pain (visual analog scale) and opioid use (oral morphine equivalents, OME), was performed with both bivariate and multivariate analysis. Additional outcomes explored included length of stay (LOS) and reconstructive intervention by plane of prosthetic reconstruction. Results A total of 146 patients were included in the final cohort. PP reconstruction was associated with higher rates of direct-to-implant reconstruction (84.9% vs. 34.3%, p Conclusion Following mastectomy, prepectoral breast reconstruction results in significantly reduced pain, opioid use, and hospital length of stay compared to subpectoral reconstruction.