Prepectoral versus Subpectoral Implant-Based Breast Reconstruction: A Literature Review of Complications, Quality of Life, and Surgical Outcomes

Abstract

Background: Reconstructive surgery following mastectomy has shifted from traditional subpectoral breast reconstruction (SBR) toward muscle-sparing prepectoral breast reconstruction (PBR). 

Aim: This review aims to systematically compare the aesthetic outcomes, surgical complication rates, and patient-reported quality of life between PBR and SBR. 

Materials and Methods: A systematic literature search was conducted across PubMed and Scopus databases (2021- 2026) in accordance with PRISMA guidelines. Out of 629 initial records, 27 full-text comparative reviews involving human subjects were selected for qualitative synthesis. 

Results: Overall major complication rates and long-term implant survival were comparable between the two methods. SBR offered greater structural coverage, reducing implant rippling and wound dehiscence. However, PBR significantly reduced early postoperative pain, opioid consumption, and eliminated animation deformity. Patients undergoing PBR reported higher satisfaction in psychosocial and sexual well-being (BREAST-Q). Both methods demonstrated equivalent safety during postmastectomy radiotherapy. 

Conclusions: Neither technique is universally superior. PBR is a highly effective, muscle-sparing alternative that optimizes recovery and dynamic aesthetics, provided there is adequate skin flap perfusion. SBR remains a reliable option for compromised tissue coverage.