BackgroundSubpectoral implant placement has traditionally been favored in implant-based breast reconstruction due to concerns about soft tissue coverage.Advances in surgical techniques and the use of acellular dermal matrix have increased interest in prepectoral placement, but more evidence on postoperative complications is needed.We compared complication rates between prepectoral and subpectoral implant placement using target trial emulation. MethodsWe included patients who underwent implant-based breast reconstruction at three Danish hospitals between 2018 and 2024.Outcomes were obtained from medical records and analyzed using double robust target trial emulation methods.The primary outcome was implant loss within two years.Secondary outcomes included implant-associated infection, hematoma, and mastectomy skin flap necrosis. ResultsA total of 940 patients (1,398 breasts) were included.Implants were placed in 439 breasts (31%) in the prepectoral plane and 959 (69%) in the subpectoral plane.The 2-year risk of implant loss was J o u r n a l P r e -p r o o f 8.4% in the prepectoral group and 7.1% in the subpectoral group (risk difference: 1.3%, P = 0.67).No significant risk differences were found for implant-associated infection (2.8%, P = 0.38), or hematoma (0.5%, P = 0.76).Mastectomy skin flap necrosis was significantly higher in the subpectoral group (3.4%, P = 0.006). ConclusionPrepectoral and subpectoral implant placement showed comparable risks of implant loss, implantassociated infection, and hematoma.The risk of mastectomy skin flap necrosis was higher in the subpectoral group.These results indicate that both approaches are comparably safe regarding the postoperative complications recorded in this study among eligible patients.
Drejøe et al. (Wed,) studied this question.