Direct-to-Implant, Prepectoral Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Year Follow-Up

Abstract

Background: Prepectoral breast reconstruction has recently experienced a resurgence in popularity. However, in direct-to-implant (DTI) reconstruction, there is no opportunity for capsular modifications before final implant insertion. Implant pocket and breast shape are thus maintained, initially, solely by the mastectomy skin flaps, and eventually, by attachments of the periprosthetic capsule. The present study aims to quantify changes in breast geometric measurements over time following DTI prepectoral breast reconstruction. Methods: A retrospective chart review was performed for patients who underwent bilateral prepectoral DTI reconstruction performed by a single surgeon from June of 2016 to January of 2018. Patients followed for more than 2 years were included. Yearly standardized frontal photographs were analyzed, and nipple-to-midline, sternal notch–to–nipple, and midclavicle–to–lower pole measurements were obtained. Patient demographics, operative details, and complications were documented. Results: A total of 72 breasts (38 women) undergoing direct-to-implant, prepectoral breast reconstruction were included in the final analysis. Acellular dermal matrix was used in 56 breasts only (78.9%) for anterior coverage. The average change in nipple-to-midline distance after 2 years decreased by 0.41 cm (range, −2.00 to 2.97 cm), sternal notch–to–nipple distance decreased by 0.62 cm (range, −4.98 to 5.4 cm), and midclavicle–to–lower pole distance decreased 0.10 cm superiorly (range, −6.07 to 3.6 cm). In breasts that underwent postmastectomy radiation therapy, the average changes were −0.08, −0.43, and −0.56 cm, respectively. No patient in this cohort had severe malposition requiring further surgery. Conclusions: The present study provides insight into geometric breast measurements following prepectoral breast reconstruction at 2-year follow-up. The minimal breast shape changes observed demonstrate the feasibility of prepectoral DTI reconstruction with or without the use of acellular dermal matrix. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.