Infection Risk and Patient-Reported Outcomes across Complete Submuscular, Partial Submuscular, and Prepectoral Tissue Expander Placement.

Abstract

Tissue expanders used in breast reconstruction can be placed in a complete submuscular, partial submuscular, or prepectoral plane. Comparative studies assessing the relationship between plane placement, infection risk, and patient-reported outcomes (PROs) remain limited. The authors hypothesize that decreasing muscle coverage is associated with higher infection risk but more favorable PROs. In this retrospective analysis of patients who underwent immediate breast reconstruction with TE placement between 2017 and 2023, patients were grouped into complete submuscular, partial submuscular with acellular dermal matrix, or prepectoral groups. Postoperative complications and BREAST-Q Physical Well-Being of the Chest (PWBC) were evaluated before second-stage reconstruction. A total of 3707 patients were included. Prepectoral placement had a higher incidence of surgical-site infection (9.1%) compared with complete submuscular (3.1%) or partial submuscular (7.1%) placement ( P < 0.001). Prepectoral reconstruction was associated with increased odds of infection (OR 2.64 [95% CI, 1.72 to 4.06]; P < 0.001) compared with complete submuscular reconstruction. However, patients with prepectoral reconstruction had higher PWBC scores (median, 76) than patients with complete or partial submuscular reconstruction (median, 72). Prepectoral reconstruction (β = 3 [95% CI, 2.0 to 4.1]; P < 0.001) and partial submuscular reconstruction (β = 1.6 [95% CI, 0.1 to 3.1]; P = 0.037) were associated with higher PWBC scores at 6 months compared with complete submuscular reconstruction. With decreasing muscle coverage, patients with tissue expander reconstruction were more likely to develop infection and less likely to have unfavorable PWBC scores. The choice among prepectoral, partial submuscular, or complete submuscular reconstruction should balance the risk of infection with PROs. Therapeutic, III.