Pre-pectoral implant-based breast reconstruction after mastectomy: a narrative review

Background and Objective: Over two million women are diagnosed with breast cancer (BC) worldwide each year and up to 40% of these require mastectomy and immediate reconstruction. Pre-pectoral breast reconstruction (PBR) is an innovative reconstructive modality capable of restoring the volume of the breast in a simple natural-looking way, by placing the implant directly above the pectoralis major muscle. The aim of this paper is to provide a narrative review of the current literature regarding PBR following mastectomy for BC with a focus on published papers in the last five years. Methods: A narrative review of the literature was carried out. The electronic database PubMed was searched for studies on PBR using the terms “breast reconstruction” and “mastectomy” and “prepectoral” or “pre-pectoral” or “subcutaneous”. The search was carried out in March 2021 including papers from January 2016 to December 2020. Studies not written in English were excluded. Key Content and Findings: (I) PBR is safe and feasible with or without meshes; (II) as compared to subpectoral reconstruction, PBR is absolutely better in terms of pain and animation deformity; (III) post-mastectomy radiotherapy after PBR is well tolerated; (IV) PBR is an alternative to standard subpectoral reconstruction in case of suboptimal aesthetic result or complications or patient unsatisfaction; (V) the application of the skin reducing mastectomy pattern to PBR allows to extend the indication to patients having large and ptotic breasts; (VI) hybrid PBR combines the natural effect of autologous reconstruction with the comfort of a PBR. Conclusions: To date, PBR should absolutely be included in the breast surgeon’s armamentarium of reconstructive procedures as it offers a relatively simple and quick one-step solution to restore the breast immediately after mastectomy.