Abstract
Background
Subpectoral implant placement in breast reconstruction has been associated with potential
shoulder function impairment compared to prepectoral placement, though the evidence
remains inconclusive. This study aimed to investigate differences in shoulder function
following mastectomy and direct-to-implant breast reconstruction using prepectoral
or subpectoral implant placement.
Methods
Forty-two women aged 18 years or older, eligible for direct-to-implant breast reconstruction,
were randomized 1:1 to undergo either prepectoral or subpectoral implant placement.
Data were collected at baseline and at 3- and 12-month follow-ups. Shoulder function
was assessed using the validated Constant Shoulder Score (CSS), which evaluates pain,
activities of daily living, range of motion, and strength. Pectoralis major muscle
(PMM) strength was also measured.
Results
Baseline and demographic characteristics were comparable between the groups. No differences
were observed in total CSS or the modified CSS (including the PMM strength) between
the prepectoral and subpectoral groups at baseline or at the 3- and 12-month follow-ups.
At 12 months, total CSS (p = 0.74) and modified CSS (p = 0.45) remained similar across both groups.
Conclusion
There were no significant differences in shoulder and arm function between the sub-
and prepectoral reconstruction groups. These findings suggest that concerns regarding
shoulder function should not dictate the choice of implant placement plane in direct-to-implant
breast reconstruction.
Keywords impaired shoulder function - functional assessment - subpectoral implant placement
- prepectoral implant placement - direct-to-implant reconstruction
