Abstract:

Objective To observe the safety and aesthetic outcomes of immediate breast reconstruction using silicone gel prosthesis combined with titanium mesh patch via prepectoral breast reconstruction（PBR） and subpectoral breast reconstruction（SBR）， and to clarify its clinical application value. Methods From April 2021 to October 2023， 171 patients who met the inclusion criteria and underwent immediate breast reconstruction with silicone gel prosthesis combined with titanium mesh patch after nipple-sparing mastectomy（NSM） or skin-sparing mastectomy（SSM） were enrolled. According to the reconstruction method， they were divided into PBR group （n=64） and subpectoral SBR group （n=107）. The clinical data of the patients in two groups were collected to analyze the intraoperative blood loss， postoperative complications， aesthetic outcomes of the reconstructed breast， and short-term follow-up results. Results The total postoperative drainage volume of the patients in PBR group was lower than that in SBR group （P=0.022）. The overall complication rate of all the patients was 39.18%， and the incidence of capsular contracture in SBR group was higher than that in PBR group （P<0.001）. There was no statistically significant difference in the excellent/good rates of the Harris scale for breast reconstruction between PBR group （93.7%） and SBR group （94.4%） （P=0.888）. At one year after operation， the scores of the BREAST-Q 2.0 scale in PBR group were significantly better than those in SBR group in terms of physical well-being（P=0.003）， psychosocial well-being（P=0.038）， and satisfaction with the reconstructed breast （P=0.034）. The regarding oncological safety， tumor recurrence and metastasis rates of the patients in PBR group and SBR group were 1.6% and 4.7%， and the difference between two groups was not statistically significant （P=0.257）. Conclusion Compared with SBR， PBR can significantly reduce the risks of breast animation deformity， capsular contracture， and rippling， and achieves better aesthetic outcomes， and improves patients’ postoperative psychological well-being. There is no significant difference in short-term oncological safety between the two surgical approaches.

Key words: Breast neoplasm, Prepectoral breast reconstruction, Subpectoral breast reconstruction, Titanium polypropylene mesh, Silicone gel prosthesis