"Acute Postoperative Complications in Prepectoral vs Subpectoral Reconstruction following Nipple-sparing Mastectomy."

BACKGROUND Nipple sparing mastectomy (NSM) is associated with improved aesthetics and oncologic safety. Recently, there has been a resurgence in prepectoral (PP) reconstruction. Due to limited data comparing complication rates on patients undergoing PP breast reconstruction, our study compared 30-day postoperative complications by plane of prosthetic placement. METHODS A retrospective review was conducted on all consecutive patients undergoing NSM with implant-based reconstruction with either prepectoral (PP) or subpectoral (SP) placement from 2014 to 2018. The primary outcome was a composite, acute 30-day postoperative complication including nipple-areola complex necrosis, mastectomy flap necrosis, wound dehiscence, infection, hematoma, and seroma. Secondary outcomes included nipple loss and rates of unintended reoperations. Univariate and mixed effects multivariate logistic regression were used to compare outcomes. RESULTS A total of 228 patients and 405 breasts were included in the final cohort with 202 in SP cohort and 203 in PP. The overall complication rate was 7.65%, with no significant difference between SP and PP (9.41% vs 5.91%, respectively; p = 0.148). PP reconstruction was associated with significantly reduced ischemic complications including nipple loss due to necrosis (2.97% vs 0.49%, respectively; p = 0.067) and mastectomy flap necrosis (5.45% vs. 0.49%, p = 0.003). There were no significant differences in rates of infection, hematoma, seroma, and implant loss/exchange. CONCLUSIONS Prepectoral reconstruction is associated with similar overall 30-day postoperative complications and reoperations compared to traditional subpectoral implants. However, PP reconstruction was associated with significantly decreased ischemic complications including mastectomy flap necrosis and nipple-areolar complex loss due to necrosis.