Comparative analysis of prepectoral and subpectoral standalone placement of MicrothaneⓇ breast implants in post-mastectomy breast reconstruction: A retrospective study

Background Breast reconstruction following mastectomy is a critical aspect of oncologic care, and the choice of implant placement significantly impacts clinical outcomes. This study evaluates the safety and efficacy of prepectoral versus subpectoral positioning of polyurethane-coated Microthane® implants, focusing on complications and the necessity of additional devices. Methods A retrospective cohort study was conducted of 93 consecutive patients (117 implants) treated between 2013 and 2019. The study analysed outcomes over a median follow-up of 3.95 years, with a range reaching 7.2 years. Using statistical methods, demographic factors and complication rates, including the impact of radiotherapy, were compared. Results Prepectoral placement exhibited a lower overall complication rate than subpectoral placement with a high statistical significance: p-value = 0.0128. The data support the standalone use of Microthane® implants in the prepectoral position without adjunctive devices such as meshes or ADMs (acellular dermal matrices), enhancing recovery and minimising costs. Despite the use of post-surgery radiotherapy on Microthane® implants, the incidence of overall capsular contracture (CC) remains consistently low, with a rate of 12%. Moreover, analysing the complications in the case of radiotherapy (both pre- and post-surgery) in prepectoral and subpectoral positions, it was statistically defined that radiotherapy was not a confounding factor. Conclusion Prepectoral positioning of Microthane® implants offers superior outcomes compared to subpectoral placement, challenging current norms in breast reconstruction practices. The use of Microthane® implants in the prepectoral position allows one to take all the advantages of the prepectoral position without additional costly devices as typically required for textured implants.