Direct-to-implant Subcutaneous Breast Reconstruction: a systematic review of complications and patient's quality of life

Abstract

Background: The use of Direct-to-implant Subcutaneous Breast Reconstruction has increased over the last years. The goal of this systematic review is to deliver an updated review of the safety of this technique and its impact on quality of life. We also compare subcutaneous vs submuscular complications, through meta-analysis. Methods: Literature review through PubMed and Cochrane Library databases were performed by PRISMA criteria. 39 studies met inclusion criteria for subcutaneous review and 15 studies met inclusion criteria for meta-analysis. All included studies were evaluated for complications and answers to the BREAST-Q. Data were analysed using Microsoft Excel, IBM SPSS, and Cochrane RevMan. Results: In 2863 patients and 3988 breasts that undergone direct to implant subcutaneous breast reconstruction, 8,21% had rippling, 5,64% seroma, 1,74% hematoma, 3,40% infection, 3,01% wound dehiscence, 3,93% skin necrosis, 3,34% nipple-areolar-complex (NAC) necrosis, 3,07% capsular contracture, 0,00% animation deformity, and 3,83% an implant removal. Meta-analysis showed statistically significant decrease in odds ratio of animation deformity, but higher odds ratio of rippling. Subcutaneous and submuscular reconstructions had similar BREAST-Q scores. Conclusions: This surgical approach is a safe method with few postoperative complications and does not affect the patient's quality of life, saving the pectoral muscle from dissection and preventing animation deformity.