Abstract：
There are mixed results in surgical complications regarding the usage of prepectoral versus subpectoral implant placement in direct-to-implant breast reconstruction. This study aimed to provide a comprehensive synthesis of surgical complications between the subpectoral and prepectoral reconstructive method.
PubMed, Embase, and Cochrane were searched for literature published up until December 2022. Studies that compared subpectoral and prepectoral breast reconstruction and reported at least one postoperative complication were included. The following 8 major outcomes were included: revision and reoperation, capsular contracture, explantation, seroma, hematoma, infection, skin necrosis, and animation deformity. Systematic review and meta-analysis were performed to compare outcomes of the 2 techniques. Subgroup analysis was performed to compare whether practice differences in different countries may have an impact on outcomes.
A total of 18 studies were identified in our literature search. Two thousand three hundred sixty patients were included, representing a total of 3135 breasts. Our analysis demonstrated that prepectoral reconstruction had significantly lower odds of developing postoperative hematoma [odds ratio (OR), 0.62; P = 0.05], seroma (OR, 0.67; P = 0.01), infection (OR, 0.64; P = 0.03), revision and reoperation (OR, 0.44; P < 0.00001), and animation deformity (OR, 0.01; P < 0.00001), compared with the subpectoral method. Subgroup analysis showed that differences between 3 countries (United States, Korea, Italy) are low (all subgroup heterogeneity test P > 0.1).
While both subpectoral and prepectoral are safe methods for breast reconstruction, the prepectoral technique may lead to lower odds of developing multiple major postoperative complications.
PubMed, Embase, and Cochrane were searched for literature published up until December 2022. Studies that compared subpectoral and prepectoral breast reconstruction and reported at least one postoperative complication were included. The following 8 major outcomes were included: revision and reoperation, capsular contracture, explantation, seroma, hematoma, infection, skin necrosis, and animation deformity. Systematic review and meta-analysis were performed to compare outcomes of the 2 techniques. Subgroup analysis was performed to compare whether practice differences in different countries may have an impact on outcomes.
A total of 18 studies were identified in our literature search. Two thousand three hundred sixty patients were included, representing a total of 3135 breasts. Our analysis demonstrated that prepectoral reconstruction had significantly lower odds of developing postoperative hematoma [odds ratio (OR), 0.62; P = 0.05], seroma (OR, 0.67; P = 0.01), infection (OR, 0.64; P = 0.03), revision and reoperation (OR, 0.44; P < 0.00001), and animation deformity (OR, 0.01; P < 0.00001), compared with the subpectoral method. Subgroup analysis showed that differences between 3 countries (United States, Korea, Italy) are low (all subgroup heterogeneity test P > 0.1).
While both subpectoral and prepectoral are safe methods for breast reconstruction, the prepectoral technique may lead to lower odds of developing multiple major postoperative complications.
摘要：
背景：在直接植入乳房重建中使用胸前植入物和胸膜下植入物的手术并发症存在混合结果。本研究旨在提供胸膜下和胸前重建方法之间的手术并发症的综合。
方法：PubMed，Embase,和Cochrane被搜索到2022年12月之前发表的文献。包括比较胸膜下和胸前乳房重建并报告至少一种术后并发症的研究。包括以下8个主要结果：修订和重新手术，包膜挛缩,外植体,血清肿,血肿,感染,皮肤坏死,和动画畸形。进行系统评价和荟萃分析以比较两种技术的结果。进行亚组分析以比较不同国家的实践差异是否可能对结果产生影响。
结果：在我们的文献检索中确定了总共18项研究。包括两千三百六十名患者，代表总共3135个乳房。我们的分析表明，胸前重建有显著较低的发生术后血肿的几率[优势比（OR），0.62；P=0.05]，血清肿（或，0.67；P=0.01），感染（或，0.64;P=0.03),修订和重新操作(或，0.44;P<0.00001),和动画畸形(OR，0.01;P<0.00001),与胸下法相比。亚组分析表明，3个国家(美国，韩国,意大利)较低(所有亚组异质性检验P>0.1)。
结论：虽然胸下和胸前都是乳房重建的安全方法，胸前技术可能导致较低的发生多种主要术后并发症的几率.
方法：PubMed，Embase,和Cochrane被搜索到2022年12月之前发表的文献。包括比较胸膜下和胸前乳房重建并报告至少一种术后并发症的研究。包括以下8个主要结果：修订和重新手术，包膜挛缩,外植体,血清肿,血肿,感染,皮肤坏死,和动画畸形。进行系统评价和荟萃分析以比较两种技术的结果。进行亚组分析以比较不同国家的实践差异是否可能对结果产生影响。
结果：在我们的文献检索中确定了总共18项研究。包括两千三百六十名患者，代表总共3135个乳房。我们的分析表明，胸前重建有显著较低的发生术后血肿的几率[优势比（OR），0.62；P=0.05]，血清肿（或，0.67；P=0.01），感染（或，0.64;P=0.03),修订和重新操作(或，0.44;P<0.00001),和动画畸形(OR，0.01;P<0.00001),与胸下法相比。亚组分析表明，3个国家(美国，韩国,意大利)较低(所有亚组异质性检验P>0.1)。
结论：虽然胸下和胸前都是乳房重建的安全方法，胸前技术可能导致较低的发生多种主要术后并发症的几率.
