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 vs 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 analyzed 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 minimizing 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, analyzing 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.
Rahman et al. (Tue,) studied this question.