Comparison of Outcomes Following Prepectoral and Subpectoral Implants for Breast Reconstruction: Systematic Review and Meta-Analysis

SIMPLE SUMMARY: Breast cancer is a growing problem in modern society and is one of the most prevalent cancers among women. Oncologic breast surgery has become an effective therapeutic modality but is often accompanied by major physical and moral impacts on patients. Implant-based reconstruction helps to restore quality of life and aims at providing an optimal esthetic recovery, although the question of implant placement has been too poorly assessed in the past years. In this meta-analysis, we collected and analyzed existing evidence on postoperative outcomes following prepectoral and subpectoral breast reconstruction and allowed us to provide one of the largest pools of patients on this topic. We observed globally higher pain scores following subpectoral implants; however, the rates of postoperative complications remained comparable in a pooled analysis. The risks and benefits of each procedure should be discussed with the patient prior to surgery, and decision making should be guided by surgical expertise. ABSTRACT: (1) Background: Implant-based breast reconstruction following mastectomy helps to restore quality of life while aiming at providing optimal cosmetic outcomes. Both prepectoral (PP) and subpectoral (SP) breast implants are widely used to fulfill these objectives. It is, however, unclear which approach offers stronger postoperative benefits. (2) Methods: We performed a systematic review of the literature through PubMed, Cochrane Library, and ResearchGate, following the PRISMA guidelines. Quantitative analysis for postoperative pain as the primary outcome was conducted. Secondary outcomes included patient satisfaction and postoperative complications such as seroma, implant loss, skin necrosis, wound infection, and hematoma. (3) Results: Nine articles involving 1119 patients were retrieved. Our results suggested increased postoperative pain after SP implants and significantly higher rates of seroma following PP implants (p < 0.05). Patient satisfaction was found to be similar between the two groups; however, the heterogeneity of measurement tools did not allow us to pool these results. The rates of implant loss, skin necrosis, wound infection, and hematoma showed no significant differences between the two cohorts. (4) Conclusion: Our data suggest that both implant placements are safe and effective methods for breast reconstruction following mastectomy. However, homogeneity in outcome measurements would allow one to provide stronger statistical results.