Beam me later: Prepectoral vs subpectoral breast reconstruction before postmastectomy radiotherapy - A systematic review and meta-analysis.

[AIM] To compare postoperative complications between prepectoral and subpectoral immediate implant-based breast reconstruction (IBBR) in patients receiving postmastectomy radiotherapy.

[METHODS] This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted in Embase, PubMed, Cochrane Library, and ClinicalTrials.gov. The meta-analysis investigated the incidence of implant loss between prepectoral and subpectoral IBBR, and odds ratios (ORs) were used to compare the incidence of dehiscence, hematoma, seroma, infection, and necrosis. Capsular contracture rates were compared as well, and complication severity was evaluated using the Clavien-Dindo classification system.

[RESULTS] The literature search, conducted in June 2024, identified 1302 studies. Fourteen met the inclusion criteria. Seven studies were included in the meta-analysis at the breast level (334 prepectoral and 448 subpectoral), and eight in the patient-level analysis (417 and 744 patients, respectively). No significant difference in implant loss was observed (breast level: OR, 0.66; p=0.22 and patient level: OR, 1.00; p=0.99). Dehiscence, hematoma, seroma, and necrosis rates were also comparable. Infection initially appeared more common in the prepectoral group (OR, 1.46; p=0.05), but this was not confirmed in the sensitivity analysis. Severity and frequency of complications, assessed using the Clavien-Dindo system, were similar between groups. One study reported higher capsular contracture rates in the subpectoral group, while the other seven studies found no difference.

[CONCLUSION] Prepectoral and subpectoral IBBR show comparable rates and severity of short- and long-term postoperative complications, suggesting similar safety profiles between approaches in selected patients receiving postmastectomy radiotherapy.