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Two-stage prosthetic breast reconstruction with latissimus flap: Prepectoral versus subpectoral approach.

Abstract

BACKGROUND

Use of latissimus flap in prosthetic breast reconstruction after mastectomy is an established approach, particularly in patients who have failed breast-conserving therapy. This study presents a comparison of the prepectoral and the subpectoral approach for two-stage prosthetic breast reconstruction with a latissimus flap.

METHODS

A retrospective review of outcomes and complications was completed between the prepectoral group (n = 33 patients, 50 reconstructed breasts) and the subpectoral group (n = 22 patients, 36 reconstructed breasts).

RESULTS

The demographics were similar between the prepectoral and subpectoral groups in terms of mean age (52.4 vs. 52.5 years, p = 0.97), smoking history (15.1% vs. 13.6%; p = 1.00), radiation history (75.8% vs. 91.0%; p = 0.28), and mean length of follow-up (479 vs. 680 days; p = 0.07). The body mass index was significantly higher in the prepectoral group (27.6 vs. 25.2 kg/m2; p = 0.03). Complications were similar between the groups in terms of hematoma (9.1% vs. 0.0%, p = 0.26), infection resulting in implant failure (9.1% vs. 4.5%, p = 0.64), thromboembolic events (3.0% vs. 4.5%, p = 1.0), donor site seroma (66.7% vs. 40.9%, p = 0.09), breast seroma (18.2% vs. 27.3%, p = 0.51), capsular contracture (9.1% vs. 4.5%, p = 0.64), animation deformity (39.4% vs. 50.0%, p = 0.58), and reoperation (24.2% vs. 22.8%, p = 1.00). Patient satisfaction scores were also similar between the groups (4.33 ± 1.08 vs. 4.14 ± 1.13, p = 0.52).

CONCLUSIONS

The prepectoral approach for two-stage immediate prosthetic reconstruction with a latissimus flap has similar outcomes and complications to those of the subpectoral approach, yet obviating the need for any pectoralis major muscle dissection.

Authors+Show Affiliations

Division of Plastic Surgery and Surgical Oncology, University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: akyurekm@ummhc.org.Division of Plastic Surgery at Beth-Israel Deaconnes Medical Center, Harvard Medical School, Boston, MA, United States.Division of Plastic Surgery and Surgical Oncology, University of Massachusetts Medical School, Worcester, MA, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31810892

Citation

Akyurek, Mustafa, et al. "Two-stage Prosthetic Breast Reconstruction With Latissimus Flap: Prepectoral Versus Subpectoral Approach." Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, 2019.
Akyurek M, Dowlatshahi S, Quinlan RM. Two-stage prosthetic breast reconstruction with latissimus flap: Prepectoral versus subpectoral approach. J Plast Reconstr Aesthet Surg. 2019.
Akyurek, M., Dowlatshahi, S., & Quinlan, R. M. (2019). Two-stage prosthetic breast reconstruction with latissimus flap: Prepectoral versus subpectoral approach. Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, doi:10.1016/j.bjps.2019.10.021.
Akyurek M, Dowlatshahi S, Quinlan RM. Two-stage Prosthetic Breast Reconstruction With Latissimus Flap: Prepectoral Versus Subpectoral Approach. J Plast Reconstr Aesthet Surg. 2019 Nov 8; PubMed PMID: 31810892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two-stage prosthetic breast reconstruction with latissimus flap: Prepectoral versus subpectoral approach. AU - Akyurek,Mustafa, AU - Dowlatshahi,Samandar, AU - Quinlan,Robert M, Y1 - 2019/11/08/ PY - 2019/06/26/received PY - 2019/08/23/revised PY - 2019/10/20/accepted PY - 2019/12/8/entrez PY - 2019/12/8/pubmed PY - 2019/12/8/medline KW - Breast reconstruction KW - Implant reconstruction KW - Latissimus flap KW - Prepectoral KW - Subpectoral JF - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JO - J Plast Reconstr Aesthet Surg N2 - BACKGROUND: Use of latissimus flap in prosthetic breast reconstruction after mastectomy is an established approach, particularly in patients who have failed breast-conserving therapy. This study presents a comparison of the prepectoral and the subpectoral approach for two-stage prosthetic breast reconstruction with a latissimus flap. METHODS: A retrospective review of outcomes and complications was completed between the prepectoral group (n = 33 patients, 50 reconstructed breasts) and the subpectoral group (n = 22 patients, 36 reconstructed breasts). RESULTS: The demographics were similar between the prepectoral and subpectoral groups in terms of mean age (52.4 vs. 52.5 years, p = 0.97), smoking history (15.1% vs. 13.6%; p = 1.00), radiation history (75.8% vs. 91.0%; p = 0.28), and mean length of follow-up (479 vs. 680 days; p = 0.07). The body mass index was significantly higher in the prepectoral group (27.6 vs. 25.2 kg/m2; p = 0.03). Complications were similar between the groups in terms of hematoma (9.1% vs. 0.0%, p = 0.26), infection resulting in implant failure (9.1% vs. 4.5%, p = 0.64), thromboembolic events (3.0% vs. 4.5%, p = 1.0), donor site seroma (66.7% vs. 40.9%, p = 0.09), breast seroma (18.2% vs. 27.3%, p = 0.51), capsular contracture (9.1% vs. 4.5%, p = 0.64), animation deformity (39.4% vs. 50.0%, p = 0.58), and reoperation (24.2% vs. 22.8%, p = 1.00). Patient satisfaction scores were also similar between the groups (4.33 ± 1.08 vs. 4.14 ± 1.13, p = 0.52). CONCLUSIONS: The prepectoral approach for two-stage immediate prosthetic reconstruction with a latissimus flap has similar outcomes and complications to those of the subpectoral approach, yet obviating the need for any pectoralis major muscle dissection. SN - 1878-0539 UR - https://www.unboundmedicine.com/medline/citation/31810892/Two-stage_prosthetic_breast_reconstruction_with_latissimus_flap:_Prepectoral_versus_subpectoral_approach L2 - https://linkinghub.elsevier.com/retrieve/pii/S1748-6815(19)30489-9 DB - PRIME DP - Unbound Medicine ER -