Postoperative Complications after Subpectoral versus Prepectoral Implant-Based Breast Reconstruction: A Target Trial Emulation Study

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This study aims to compare the rates of postoperative complications between subpectoral and prepectoral implant placements in breast reconstruction.
Included 940 patients who underwent implant-based breast reconstruction at three hospitals in Denmark from 2018 to 2024.
Analyzed outcomes from medical records using double robust target trial emulation methods.
Primary outcome assessed was implant loss within two years, with secondary outcomes including infection, hematoma, and skin flap necrosis.
The 2-year risk of implant loss was 8.4% in prepectoral vs. 7.1% in subpectoral (risk difference: 1.3%, P = 0.67).
Implant-associated infection rates were 2.8% (P = 0.38) and hematoma rates 0.5% (P = 0.76) with no significant differences.
Mastectomy skin flap necrosis occurred in 3.4% of subpectoral patients, significantly higher than in prepectoral.

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Target trial emulation compares implant loss and complications in breast reconstruction methods, suggesting safety in both approaches.

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Drejøe et al. (2026) studied this question.

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