Infection risk and patient-reported outcomes across complete submuscular, partial submuscular, and prepectoral tissue expander placement Journal Article
| Authors: | Shammas, R. L.; Wang, J.; Boe, L. A.; Levy, J.; Kim, M.; Mehrara, B. J.; Nelson, J. A.; Rochlin, D. H. |
| Article Title: | Infection risk and patient-reported outcomes across complete submuscular, partial submuscular, and prepectoral tissue expander placement |
| Abstract: | INTRODUCTION Tissue expanders (TE) used in breast reconstruction can be placed in a complete submuscular, partial submuscular, or prepectoral plane. Comparative studies assessing the relationship between plane placement, infection risk, and patient-reported outcomes (PROs) remain limited. We hypothesize that decreasing muscle coverage is associated with higher infection risk yet more favorable PROs. METHODS Retrospective analysis of patients who underwent immediate breast reconstruction with TE placement between 2017-2023. Patients were grouped as complete submuscular, partial submuscular with acellular dermal matrix (ADM), and prepectoral. Postoperative complications and BREAST-Q Physical Well-Being of the Chest (PWBC) were evaluated before second-stage reconstruction. RESULTS A total of 3,707 patients were included. Prepectoral placement had a higher incidence of surgical site infection (9.1%) compared to complete submuscular (3.1%) and partial submuscular (7.1%) placement (p<0.001). Prepectoral reconstruction was associated with increased odds of infection (OR 2.64, 95% CI: 1.72-4.06; p<0.001) compared to complete submuscular. However, prepectoral patients had higher PWBC scores (median, 76) than complete and partial submuscular patients (median, 72). Prepectoral (β=3, 95% CI: 2.0-4.1; p<0.001) and partial submuscular (β=1.6, 95% CI: 0.1-3.1; p=0.037) were associated with higher PWBC scores at six months compared to complete submuscular. CONCLUSION With decreasing muscle coverage, patients reconstructed with tissue expanders were more likely to develop infection and less likely to have unfavorable PWBC scores. The choice between prepectoral, partial submuscular, and complete submuscular reconstruction should balance the risk of infection with PROs. Copyright © American Society of Plastic Surgeons. All rights reserved. |
| Keywords: | breast reconstruction; outcomes; tissue expander; prepectoral; subpectoral |
| Journal Title: | Plastic and Reconstructive Surgery |
| ISSN: | 0032-1052 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2025-05-06 |
| Language: | English |
| DOI: | 10.1097/prs.0000000000012185 |
| PROVIDER: | scopus |
| PUBMED: | 40327830 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author is Danielle H. Rochlin -- Source: Scopus |
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