Background: Implant-based breast reconstruction is the most used approach for breast reconstruction following mastectomy. Prosthetic breast reconstruction helps achieve optimal results with reduced operation time, offering advantages over direct-to-implant and subpectoral reconstruction in selected patients. This study aimed to provide a comprehensive overview of the two-stage prepectoral breast reconstruction. Methods: A systematic literature search was performed, and the search was conducted across the PubMed, Cochrane, and Embase databases by adhering to the preferred reporting items for systematic reviews and meta-analysis guidelines. The inclusion criteria encompassed clinical trials or randomized clinical trials related to completed two-stage prepectoral breast reconstruction. Statistical analyses were conducted to synthesize the data and evaluate outcomes. Results: A total of 48 articles were included for analysis, evaluating 4461 patients and 3894 breasts. The most commonly performed mastectomy type was skin-sparing mastectomy, followed by nipple-areola complex-sparing mastectomy. For the first surgical step, the mean tissue expander size was 423.64 cc, with a mean final expander fill of 349.10 cc. The mean time between the first and second surgery stages was 6.21 months, and the mean follow-up time was 17.10 months. A total of 21.27% of the patients experienced at least one complication. Specifically, seroma was identified in 11.19%, infection in 8.97%, skin flap necrosis in 8.48%, capsular contracture in 6.74%, rippling/wrinkling in 11.30%, expander or implant exposure in 2.38%, and implant removal in 8.62% of the patients. Conclusions: Two-stage prepectoral breast reconstruction is a viable surgical option for selected patients. The most frequent complication was seroma. Adjuvant radiotherapy was associated with a higher rate of infection and implant removal. (c) 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Two-stage prepectoral breast reconstruction: A comprehensive review and meta-analysis
Vinci, Valeriano
2025-01-01
Abstract
Background: Implant-based breast reconstruction is the most used approach for breast reconstruction following mastectomy. Prosthetic breast reconstruction helps achieve optimal results with reduced operation time, offering advantages over direct-to-implant and subpectoral reconstruction in selected patients. This study aimed to provide a comprehensive overview of the two-stage prepectoral breast reconstruction. Methods: A systematic literature search was performed, and the search was conducted across the PubMed, Cochrane, and Embase databases by adhering to the preferred reporting items for systematic reviews and meta-analysis guidelines. The inclusion criteria encompassed clinical trials or randomized clinical trials related to completed two-stage prepectoral breast reconstruction. Statistical analyses were conducted to synthesize the data and evaluate outcomes. Results: A total of 48 articles were included for analysis, evaluating 4461 patients and 3894 breasts. The most commonly performed mastectomy type was skin-sparing mastectomy, followed by nipple-areola complex-sparing mastectomy. For the first surgical step, the mean tissue expander size was 423.64 cc, with a mean final expander fill of 349.10 cc. The mean time between the first and second surgery stages was 6.21 months, and the mean follow-up time was 17.10 months. A total of 21.27% of the patients experienced at least one complication. Specifically, seroma was identified in 11.19%, infection in 8.97%, skin flap necrosis in 8.48%, capsular contracture in 6.74%, rippling/wrinkling in 11.30%, expander or implant exposure in 2.38%, and implant removal in 8.62% of the patients. Conclusions: Two-stage prepectoral breast reconstruction is a viable surgical option for selected patients. The most frequent complication was seroma. Adjuvant radiotherapy was associated with a higher rate of infection and implant removal. (c) 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
