Prevention of Postoperative Complications by Prepectoral versus Subpectoral Breast Reconstruction: A Systematic Review and Meta-Analysis

Background: Implant-based breast reconstruction has evolved over time. However, the effects of prepectoral breast reconstruction (PBR) compared with those of subpectoral breast reconstruction (SBR) have not been clearly defined. Therefore, this study aimed to compare the occurrence of surgical complications between PBR and SBR to determine the procedure that is effective and relatively safe. Methods: PubMed, Cochrane Library, and EMBASE databases were searched for studies published until April 2021 comparing PBR and SBR postmastectomy. Two authors independently assessed the risk of bias. General information on the studies and surgical outcomes were extracted. Among 857 studies, 34 and 29 were included in the systematic review and meta-analysis, respectively. Subgroup analysis was performed to clearly compare the results of patients who underwent postmastectomy radiation therapy (PMRT). Results: Pooled results showed that prevention of capsular contracture (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.41–0.79) and infection control (OR 0.73, 95% CI 0.58–0.92) were better with PBR than with SBR. Rates of hematoma, implant loss, seroma, skin-flap necrosis, and wound dehiscence were not significantly different between PBR and SBR. PBR considerably improved postoperative pain, BREAST-Q score, and upper arm function compared with SBR. Among PMRT patients, the incidence rates of capsular contracture were significantly lower in the PBR group than in the SBR group (OR 0.14, 95% CI 0.05–0.35). Conclusions: The results showed that PBR had fewer postoperative complications than SBR. Our meta-analysis suggests that PBR could be employed as an alternative technique for breast reconstruction in appropriate patients.