Prepectoral Versus Subpectoral Implant-based Breast Reconstruction: Evaluation of the Aesthetic Outcomes by Plastic Surgeons and General Practitioners. Prepectoral vs subpectoral breast reconstruction: aesthetic outcomes assessment.

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Francesca Romana Grippaudo
Michele Delle Monache
Diego Ribuffo


Breast implants, DTI reconstruction, Skin Sparing mastectomy, Nipple sparing mastectomyy, Aesthetic assessment, Questionnaire


Background: In breast reconstruction after skin or nipple sparing mastectomy, breast implants may be placed in subpectoral or prepectoral position. In the literature a comparative evaluation of aesthetic outcomes after these two techniques is lacking.

 Aim: This study aims to evaluate the aesthetic outcomes of breast reconstruction after these reconstructive techniques by mean of a questionnaire.

  Methods: This retrospective observational study concerns patients receiving breast reconstruction with prosthesis from 2018 to 2021, after skin or nipple sparing mastectomy. Inclusion criteria were the presence of a pre- and postoperative breast measurements, and preoperative and one year follow-up photographs. Aesthetic assessment was done by a panel of Plastic Surgeons and General Practitioners by mean of a questionnaire, inquiring the overall aesthetic aspect of breast area pre and postoperatively. General practitioners and surgeons’ judgements were statistically analyzed. Correlation between single items and overall aesthetic outcome was analyzed and inter-observer variability was assessed.

Results: Twenty-six breast reconstructions (14 prepectoral and 12 subpectoral) were considered. The mean ratings of plastic surgeons were higher than those of General Practitioners. No statistically significant differences were found between the postoperative ratings of the two techniques. Volume and shape were found to be most correlated with overall satisfaction. The degree of intraclass correlation was generally high, but it was higher for general practitioners.

Conclusions: Subpectoral and prepectoral techniques were superimposable regarding aesthetic outcomes. General Practitioners' ratings were lower on average, showing a difference in aesthetic evaluation criteria between the two categories.

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