Prepectoral Versus Subpectoral Implant-based Breast Reconstruction: Evaluation of the Aesthetic Outcomes by Plastic Surgeons and General Practitioners

Abstract. Background: In breast reconstruction after skin or nipple sparing mastectomy, breast implants may be placed in a subpectoral or prepectoral position. In the literature a comparative evaluation of aesthetic outcomes after these two techniques is lacking. Aim: This study aims to evaluate the aesthetic outcomes of breast reconstruction surgery after these reconstructive techniques by mean of a questionnaire. Methods: This retrospective observational study concerns patients receiving breast implant reconstruction from 2018 to 2021, after a skin or nipple sparing mastectomy. The inclusion criteria were the presence of pre- and postoperative breast measurements, and preoperative and one year follow-up photographs. An aesthetic assessment was done by a panel of Plastic Surgeons and General Practitioners by mean of a questionnaire, inquiring the overall aesthetic aspect of the breast area pre and postoperatively. The judgment of general practitioners and surgeons were statistically analyzed. The correlation between individual points single items and the overall aesthetic outcome was analyzed and the inter-observer variability was assessed. Results: Twenty-six breast reconstructions (14 prepectoral and 12 subpectoral) were considered. The mean ratings of plastic surgeons were higher than those of General Practitioners. No statistically significant differences were found between the postoperative ratings of the two techniques. Volume and shape were found to be most correlated with the overall level of satisfaction. The degree of intraclass correlation was generally high, but it was higher for general practitioners. Conclusions: Subpectoral and prepectoral techniques were superimposable to achieve satisfying aesthetic outcomes. The General Practitioners’ ratings were lower on average, showing a difference in the aesthetic evaluation criteria between the two categories.