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September 14, 2026Plastic & Reconstructive Surgery

Prospective Comparison of Long-Term Outcomes in Prepectoral vs. Subpectoral Implant Breast Reconstruction After Post-Mastectomy Radiotherapy

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Authors

EREva RoySAShailesh AgarwalRPRinaa S. Punglia

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Overview

Randomized trial finds similar long-term outcomes between prepectoral and subpectoral breast reconstruction after radiotherapy, indicating patient factors primarily drive aesthetic results.

Key Points

  • To prospectively compare long-term complication rates, aesthetic results, and patient-reported outcomes between prepectoral and subpectoral implant-based breast reconstruction following post-mastectomy radiotherapy.
  • Data were derived from the multicenter randomized FABREC trial evaluating 380 patients who received either prepectoral (n=224) or subpectoral (n=156) implant-based reconstruction.
  • Blinded reviewers assessed aesthetic outcomes, and participants completed the FACT-B and BREAST-Q Reconstruction Module questionnaires at 6 and 18 months after post-mastectomy radiotherapy.
  • Multivariable regression models were used to identify associations between the surgical plane of reconstruction and long-term outcomes after controlling for patient covariates.
  • Patient-reported outcomes showed no statistically significant differences between prepectoral and subpectoral reconstruction at 6 or 18 months across all FACT-B and BREAST-Q domains, though higher body mass index correlated with lower sexual well-being at both intervals (Estimate -0.60, p=0.03).
  • Subpectoral reconstruction was associated with lower aesthetic scores compared to prepectoral reconstruction at 6 months, but only increasing age persisted as an independent predictor of poorer aesthetic outcomes at 18 months (Estimate -0.02, p=0.00).

Cite This Study

Roy et al. (2026) studied this question.

synapsesocial.com/papers/6aa7b2b20926e14a848b1353https://doi.org/10.1097/prs.0000000000013455
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Patient-Reported Outcomes and Complication Profiles of Implant-Based Breast Reconstruction in Patients With Postmastectomy Radiation Therapy2024 · 3 citations
  2. 2Abstract PO3-23-04: Patient-reported outcomes and complication profiles of implant-based breast reconstruction in patients with postmastectomy radiation therapy2024
  3. 3P8. Comparative Outcomes of Proton versus Photon Post-Mastectomy Radiation Therapy in Pre-pectoral Implant Based Breast Reconstruction2024
  4. 4Abstract PO2-22-12: Patient-reported outcomes 3 and 18 months after prepectoral implant-based breast reconstruction: Results from the UK Pre-BRA multicentre prospective cohort study2024
  5. 5ThP1.13 - Short term safety outcomes of immediate pre-pectoral implant based reconstruction2024