Objective

Implant-based breast reconstruction following mastectomy helps to restore the patient’s quality of life while aiming at providing optimal cosmetic outcomes. Both prepectoral (PP) and subpectoral (SP) breast implants are widely used to fulfill these objectives. It is however unclear whether one of these two options offers stronger postoperative benefits.
 
Methods

We performed a systematic search of the English literature through PubMed, Cochrane Library and ResearchGate following the PRISMA guidelines. Postoperative pain was the primary outcome assessed. Secondary outcomes included patient’s satisfaction and postoperative complication rates such as seroma, hematoma and infection.
 
Results

A total of nine articles involving 1802 patients were retrieved, corresponding to 502 (28%) PP and 1300 (72%) SP breast implants. The majority of articles suggested higher rates of postoperative pain following SP implants, however the heterogeneity in pain assessment did not allow us to perform a comprehensive meta-analysis regarding this outcome. The rates of seroma after surgery on the other hand were higher in PP patients and overall satisfaction as well as the rates of infection and hematoma showed no significant differences between the two cohorts.
 
Conclusion

Our data suggest that both PP and SP implants are safe and effective methods for breast reconstruction following mastectomy although PP implants tend to provide better results in terms of postoperative pain. Yet, standardization in pain assessment would allow one to provide stronger statistical results. The risks and benefits of each procedure should be fully discussed with the patient prior to surgery and decision making should be guided by the expertise of the surgeon.