{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:31:14Z","timestamp":1790627474032,"version":"4.1.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"06","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":875,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T00:00:00Z","timestamp":1573776000000},"content-version":"tdm","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-aps.org"],"crossmark-restriction":true},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>Background  In recent years, breast implants have been frequently placed in the subcutaneous pocket, in the so-called prepectoral approach. We report our technique of prepectoral implant-based breast reconstruction (IBR), as well as its surgical and aesthetic outcomes, in comparison with subpectoral IBR. We also discuss relevant considerations and pitfalls in prepectoral IBR and suggest an algorithm for the selection of patients for IBR based on our experiences.<\/jats:p>\n                  <jats:p>Methods  We performed 79 immediate breast reconstructions with a breast implant and an acellular dermal matrix (ADM) sling, of which 47 were subpectoral IBRs and 32 were prepectoral IBRs. Two-stage IBR was performed in 36 cases (20 subpectoral, 16 prepectoral), and direct-to-implant IBR in 43 cases (27 prepectoral, 16 subpectoral). The ADM sling supplemented the inferolateral side of the breast prosthesis in the subpectoral group and covered the entire anterior surface of the breast prosthesis in the prepectoral group.<\/jats:p>\n                  <jats:p>Results  The postoperative pain score was much lower in the prepectoral group than in the subpectoral group (1.78 vs. 7.17). The incidence of seroma was higher in the prepectoral group (31.3% vs. 6.4%). Other postoperative complications, such as surgical site infection, flap necrosis, implant failure, and wound dehiscence, occurred at similar rates in both groups. Animation deformities developed in 8.5% of patients in the subpectoral group and rippling deformities were more common in the prepectoral group (21.9% vs. 12.8%).<\/jats:p>\n                  <jats:p>Conclusions  The indications for prepectoral IBR include moderately-sized breasts with a thick well-vascularized mastectomy flap and concomitant bilateral breast reconstruction with prophylactic mastectomy.<\/jats:p>","DOI":"10.5999\/aps.2019.00353","type":"journal-article","created":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T19:49:46Z","timestamp":1574192986000},"page":"550-557","update-policy":"https:\/\/doi.org\/10.5999\/crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Considerations for patient selection: Prepectoral versus subpectoral implant-based breast reconstruction"],"prefix":"10.1055","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4995-9813","authenticated-orcid":false,"given":"Jun Young","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7441-8480","authenticated-orcid":false,"given":"Chan Woo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-5878","authenticated-orcid":false,"given":"Jang Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Ki","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Ah","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0077-3092","authenticated-orcid":false,"given":"Euna","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/00006534-198103000-00007","article-title":"Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques","volume":"67","author":"RP Gruber","year":"1981","journal-title":"Plast Reconstr Surg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1097\/00006534-197812000-00004","article-title":"Loss of silicone implants after subcutaneous mastectomy and reconstruction","volume":"62","author":"JD Schlenker","year":"1978","journal-title":"Plast Reconstr Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1097\/00006534-197106000-00008","article-title":"Reconstruction of the female breast following radical mastectomy","volume":"47","author":"RK Snyderman","year":"1971","journal-title":"Plast Reconstr Surg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/00000637-198109000-00006","article-title":"Submuscular breast reconstruction: indications and techniques","volume":"7","author":"DB Apfelberg","year":"1981","journal-title":"Ann Plast Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1067\/maj.2001.113438","article-title":"Correction of implant rippling using allograft dermis","volume":"21","author":"DI Duncan","year":"2001","journal-title":"Aesthet Surg J"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/01.sap.0000168527.52472.3c","article-title":"Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings","volume":"55","author":"KH Breuing","year":"2005","journal-title":"Ann Plast Surg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1007\/s00266-008-9128-8","article-title":"Acellular dermis-assisted breast 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Sbitany","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1007\/s00266-018-1117-y","article-title":"Rippling following breast augmentation or reconstruction: aetiology, emerging treatment options and a novel classification of severity","volume":"42","author":"NM Pantelides","year":"2018","journal-title":"Aesthetic Plast Surg"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/SAP.0b013e3182a7cc9b","article-title":"Minimizing complications with the use of acellular dermal matrix for immediate implant-based breast reconstruction","volume":"71","author":"I Ganske","year":"2013","journal-title":"Ann Plast Surg"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/PRS.0000000000002331","article-title":"Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience","volume":"138","author":"CA Salzberg","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1097\/PRS.0b013e318230c29e","article-title":"Acellular dermis-assisted prosthetic breast reconstruction: a systematic and critical review of efficacy and associated morbidity","volume":"128","author":"H Sbitany","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1097\/SLA.0000000000003054","article-title":"Implant based breast reconstruction with acellular dermal matrix: safety data from an open-label, multicenter, randomized, controlled trial in the setting of breast cancer treatment","volume":"269","author":"F Lohmander","year":"2019","journal-title":"Ann Surg"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"22S","DOI":"10.1097\/PRS.0000000000004047","article-title":"Two-stage prosthetic breast reconstruction: a comparison between prepectoral and partial subpectoral techniques","volume":"140","author":"MY Nahabedian","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"S64","DOI":"10.21037\/gs.2018.03.05","article-title":"Acellular dermal matrix in implant-based immediate breast reconstructions: a comparison of prepectoral and subpectoral approach","volume":"7","author":"MN Chandarana","year":"2018","journal-title":"Gland Surg"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/PRS.0000000000004270","article-title":"A prospective comparison of short-term outcomes of subpectoral and prepectoral Strattice-based immediate breast reconstruction","volume":"141","author":"BG Baker","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.radonc.2014.11.030","article-title":"ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer","volume":"114","author":"BV Offersen","year":"2015","journal-title":"Radiother Oncol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.radonc.2019.04.010","article-title":"ESTRO ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer","volume":"137","author":"O Kaidar-Person","year":"2019","journal-title":"Radiother Oncol"}],"container-title":["Archives of Plastic 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