Ricerc@Sapienza

Summary Recently, prepectoral breast reconstruction is experiencing a revival. Despite the
growing body of early reports about subcutaneous breast reconstruction, literature lacks in
long-term results and studies focusing on patient-reported outcomes and health-related quality
of life.
Between January 2012 and December 2016, patients undergoing mastectomy were enrolled at
our institution. We selected patients diagnosed with breast cancer or genetic predisposition
to breast cancer, undergoing conservative mastectomy, either nipple-sparing or skin-sparing
mastectomy, and willing for prepectoral tissue expander reconstruction assisted by a synthetic mesh. Exclusion criteria were body mass index greater than 35 kg/m2 and pregnancy.
BREAST-Q questionnaire was administered prior to surgery and after 1 year. Capsular contracture was evaluated using Baker scale. Oncological, surgical, and esthetic outcomes along with
the changes in BREAST-Q score were analyzed over time. One hundred eighty-seven patients were enrolled, with an average age of 55.5 years. One hundred thirty-seven unilateral mastectomy and 50 bilateral mastectomy procedures were performed, accounting for a total of 237 operated breasts. The average follow-up period after the
second stage was 36.5 months. Postoperative complications that require a second operation
occurred in 16 cases (6.7%) (4 wound dehiscence, 2 skin–nipple necrosis, 7 infections, and 3
seroma cases). A locoregional recurrence occurred in 3 cases (1.9%) and a systemic recurrence
occurred in 2 cases (1.3%). Patients scored high level of satisfaction with outcome. Overall
satisfaction with breasts, psychosocial well-being, and sexual well-being was all significantly
increased after the surgery (p < 0.05).
Two-stage expander reconstruction technique provides the preservation of the pectoralis major
muscle with an acceptable rate of complications. We confirm satisfactory patient-reported and
esthetic results, with high patient comfort.