Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

Lynne N. Bettinger, MD; Linda M. Waters, MD, CM; Stephen W. Reese, MD, MA; Susan E. Kutner, MD; Daniel I. Jacobs, MD

doi:10.1097/GOX.0000000000001433

Plastic and Reconstructive Surgery, Global Open (Jul 2017)

Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

Lynne N. Bettinger, MD,
Linda M. Waters, MD, CM,
Stephen W. Reese, MD, MA,
Susan E. Kutner, MD,
Daniel I. Jacobs, MD

Affiliations

Lynne N. Bettinger, MD: 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.
Linda M. Waters, MD, CM: 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.
Stephen W. Reese, MD, MA: 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.
Susan E. Kutner, MD: 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.
Daniel I. Jacobs, MD: 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.

DOI: https://doi.org/10.1097/GOX.0000000000001433
Journal volume & issue: Vol. 5, no. 7

Abstract

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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 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.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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