Prepectoral vs. Submuscular Immediate Breast Reconstruction in Patients Undergoing Mastectomy after Neoadjuvant Chemotherapy: Our Early Experience

Lorenzo Scardina; Alba Di Leone; Ersilia Biondi; Beatrice Carnassale; Alejandro Martin Sanchez; Sabatino D'Archi; Antonio Franco; Francesca Moschella; Stefano Magno; Daniela Terribile; Damiano Gentile; Alessandra Fabi; Anna D'Angelo; Liliana Barone Adesi; Giuseppe Visconti; Marzia Salgarello; Riccardo Masetti; Gianluca Franceschini

doi:10.3390/jpm12091533

Prepectoral vs. Submuscular Immediate Breast Reconstruction in Patients Undergoing Mastectomy after Neoadjuvant Chemotherapy: Our Early Experience

J Pers Med. 2022 Sep 19;12(9):1533. doi: 10.3390/jpm12091533.

Authors

Lorenzo Scardina^{1

2}, Alba Di Leone¹, Ersilia Biondi¹, Beatrice Carnassale¹, Alejandro Martin Sanchez¹, Sabatino D'Archi¹, Antonio Franco¹, Francesca Moschella¹, Stefano Magno¹, Daniela Terribile¹, Damiano Gentile³, Alessandra Fabi⁴, Anna D'Angelo⁵, Liliana Barone Adesi¹, Giuseppe Visconti¹, Marzia Salgarello¹, Riccardo Masetti¹, Gianluca Franceschini¹

Affiliations

¹ Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
² Multidisciplinary Breast Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy.
³ Breast Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy.
⁴ Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
⁵ Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.

Abstract

Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR) is an oncologically accepted technique that offers improved esthetic results and patient quality of life. Traditionally, implants have been placed in a submuscular (SM) plane beneath the pectoralis major muscle (PMM). Recently, prepectoral (PP) placement of the prosthesis has been increasingly used in order to avoid morbidities related to manipulation of the PMM. The aim of this study was to compare outcomes of SM vs. PP IPBR after conservative mastectomy in patients with histologically proven breast cancer treated with neoadjuvant chemotherapy (NAC).

Methods: In this retrospective observational study, we analyzed two cohorts of patients that underwent mastectomy with IPBR after NAC in our institution from January 2018 to December 2021. Conservative mastectomy was performed in 146 of the 400 patients that underwent NAC during the study period. Patients were divided into two groups based on the positioning of implants: 56 SM versus 90 PP.

Results: The two cohorts were similar for age (mean age 42 and 44 years in the SM and PP group respectively) and follow-up (33 and 20 months, respectively). Mean operative time was 56 min shorter in the PP group (300 and 244 min in the SM and PP group). No significant differences were observed in overall major complication rates. Implant loss was observed in 1.78% of patients (1/56) in the SM group and 1.11% of patients (1/90) in PP group. No differences were observed between the two groups in local or regional recurrence.

Conclusions: Our preliminary experience, which represents one of the largest series of patients undergoing PP-IPBR after NAC at a single institution documented in the literature, seems to confirm that PP-IPBR after NAC is a safe, reliable and effective alternative to traditional SM-IPBR with excellent esthetic and oncological outcomes; it is easy to perform, reduces operative time and minimizes complications related to manipulation of PPM. However, this promising results need to be confirmed in prospective trials with longer follow-up.

Keywords: breast cancer; immediate prosthetic breast reconstruction; mastectomy; neoadjuvant chemotherapy.

Grants and funding

This research received no external funding.