Comparison of prepectoral and subpectoral breast reconstruction after mastectomies: A systematic review and meta analysis.

[BACKGROUND] The safety of prepectoral breast reconstruction (PBR) after mastectomies as compared to subpectoral breast reconstruction (SBR) were unclear, so we conducted a systematic review to analyze their differences.

[METHODS] PubMed, EMBASE, the Cochrane Library, and Web of Science databases were searched to retrieve studies that compared PBR with SBR after mastectomies. The outcomes were complications, oncological safety, patient-reported outcomes and postoperative pain. Revman software version 5.30 and stata vesion 12 was used to conduct meta-analysis where possible.

[RESULTS] 16 comparative studies (12 articles and four abstracts) were included. The meta analysis showed no statistical differences in overall complications, implant loss, seroma, nipple or skin flap necrosis, hematoma, reoperation, wound dehiscence, and wound-skin infection, rippling between PBR and SBR. PBR might be associated with fewer nipple or skin flap necrosis for those who received tissue expander placement, and fewer capsular contracture rates for those who received implant. PBR might be associated with better Breast Q scores and less postoperative pain without increasing the risk of local recurrence and metastatic disease.

[CONCLUSION] Although available evidence is limited, PBR might be as safe as subpectoral approach. Future well designed multicenter randomized controlled trial that compare postmastectomy PBR with SBR is needed.