A presentation at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting highlighted success with an alternative approach to mastectomy with immediate prosthetic breast reconstruction (IPBR). The authors described their experiences with prepectoral implant placement, rather than the traditional submuscular placement beneath the pectoralis major muscle (PMM).
“Conservative mastectomy with IPBR is an oncologically accepted technique that allows us to improve aesthetic results and patient quality of life,” wrote the authors, led by Lorenzo Scardina, of the Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, in Rome, Italy. “Prepectoral placement of prosthesis is increasingly used in order to avoid morbidities related to manipulation of the PMM.”
The authors conducted a retrospective, observational study of 2 cohorts of patients at their institution. Both groups received mastectomy with IPBR after neoadjuvant chemotherapy for histologically proven breast cancer between January 2018 and December 2021 (N = 155).
One group received submuscular implantation of the breast prosthesis (n = 60), whereas the other received prepectoral placement (n = 95). The groups were otherwise similar with respect to age and follow-up: Mean ages were 45 years in the submuscular group and 42 years in the prepectoral group, and mean follow-up periods were 32 and 21 months, respectively.
The authors compared outcomes between the groups, finding no significant differences in rates of complications, implant loss, or local or regional recurrence of cancer. Operative time was a mean 55 minutes less in the prepectoral group compared to the submuscular group. Mean operative time was 55 minutes shorter in the prepectoral group (243 minutes vs 298 minutes).
The authors believe that their study represents the largest published series of prepectoral IPBR after neoadjuvant chemotherapy at a single institution. They concluded that their work appears to confirm that the approach is “a safe, reliable, and effective alternative to traditional submuscular IPBR, with excellent aesthetic and oncological outcomes. It is easy to perform, reduces operative time, and minimizes complications related to manipulation of the PMM.”
They recommended that future research involve prospective trials with longer follow-up periods.