Efficacy and safety of prepectoral versus subpectoral implant-based breast reconstruction: a systematic review
DOI:
https://doi.org/10.51798/sijis.v6i4.1016Keywords:
breast reconstruction; prepectoral implant; subpectoral implant; outcomes; complicationsAbstract
Background: Implant-based breast reconstruction (IBBR) is the most common post-mastectomy reconstructive approach. Optimal implant placement, prepectoral (PP) versus submuscular (SP), remains debated with respect to safety, complications, and cosmetic outcomes. This review summarizes comparative evidence published since 2015 to evaluate the effectiveness and safety of these techniques. Methods: Following PRISMA, PubMed, Scopus, Web of Science, and the Cochrane Library were searched for comparative studies published between January 2015 and September 2025. Eligible studies directly compared PP and SP IBBR in adult women. Outcomes included complications, patient-reported satisfaction, and aesthetic results. Study quality was assessed using appropriate tools (e.g., MINORS), and a scientometric analysis of publication trends was performed. Results: Analysis showed that PP reconstruction significantly reduced breast animation deformity (pooled OR 0.02–0.37) and early postoperative pain compared with SP placement. PP was also associated with a moderate reduction in capsular contracture risk (pooled OR −0.54). However, PP reconstruction demonstrated higher risks of seroma (OR 1.55) and implant rippling (OR 2.39). Rates of infection, implant loss, and reoperation were generally comparable between techniques, though substantial heterogeneity was observed. Patient-reported outcomes were inconsistent, with no uniform superiority of either method across domains. Conclusions: Prepectoral IBBR offers clear advantages in reducing animation deformity and early postoperative pain, with potential benefit regarding capsular contracture, at the cost of increased seroma and rippling. Overall, major complication rates are similar, supporting PP reconstruction as a safe and effective option in selected patients. Further long-term prospective studies are needed to refine patient selection and standardize techniques.
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Copyright (c) 2025 Luis Eduardo Morillo Lemus, Lincoln Xavier Naranjo Palacio, Juan Carlos Aranda Crisólogo, Zeus Edrian Daniel Alfonso González Mercado, Gabriela Gomez Orozco, Christopher Giovanni Vega Flores
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