176. Obese Patients Have Better Surgical Outcomes With Prepectoral Compared With Subpectoral Implant Placement

PURPOSE: Plastic surgeons are faced more and more with the challenges of reconstructing patients with high BMI. The goal of this study is to evaluate the surgical and patient-reported outcomes(PROs) of obese patients who underwent prepectoral vs. subpectoral breast reconstruction METHODS: We conducted a retrospective review of patients who underwent two-stage implant-based breast reconstruction(IBR) between January 2017 and December 2019. Our primary endpoint was overall complications. Secondary outcomes included major complications (complications requiring surgical intervention or device explantation) and PROs(BREAST-Q). RESULTS: We identified a total of 209 patients (284 reconstructions) with BMI ≥ 30 who met the inclusion criteria[184 prepectoral reconstruction, 65%; and 100 subpectoral reconstructions, 35%]. The overall complication rate was significantly higher in the subpectoral group (50% vs. 37%, p=0.047) and device explantation in the subpectoral group was 2-fold higher than that in the prepectoral group (25%vs.12.5%,p=0.008). Subpectoral reconstruction was associated with nearly twice the hazard ratio of device explantation on the multiple Cox proportional hazards regression model [HR 1.97; 95% CI, 1.05 - 3.68; p=0.034]. No significant differences in mean scores for satisfaction with the breast, psychosocial well-being, and sexual well-being were identified between the two groups(p=0.47,p=0.91,p=0.93,respectively). CONCLUSION: Prepectoral breast reconstruction was associated with significantly decreased overall breast-related complications, infections, and device explantation compared to subpectoral breast reconstruction when performed in obese patients. Therefore, not only is the prepectoral technique not contraindicated in this patient population, but the results are superior to the subpectoral technique. In this patient population, we recommend using the prepectoral technique for IBR.