Two-stage breast reconstruction comparison between prepectoral tissue expander wrapped within acellular dermal matrix versus subpectoral placement: the prospective observational EX-BRAX study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Implant-based breast reconstruction (IBBR) has progressively shifted toward prepectoral techniques to improve cosmetic outcomes and reduce postoperative morbidity. However, comparative evidence between prepectoral and subpectoral tissue expander (TE) placement remains very limited. The aim of this study was to prospectively compare postoperative pain and early complications between prepectoral ADM-assisted and subpectoral tissue expander-based breast reconstruction in a real-world clinical setting.Methods: This prospective monocentric observational study compared patients undergoing two-stage IBBR with either prepectoral TE wrapped within acellular dermal matrix (ADM) or subpectoral expanders without ADM. Primary outcomes included postoperative pain [Numeric Pain Rating Scale (NPRS)] and early complications (<30 days). Secondary variables included surgical data and hospital stay. Minimum follow-up: 6 months.Results: Fifty-six patients (59 breasts) were included: 27 patients (29 breasts) in the prepectoral group and 29 patients (30 breasts) in the subpectoral group. Postoperative pain was significantly lower in the prepectoral group at all timepoints (day 1: 3.79±2.32 vs. 5.3 ± 1.82, P<0.01; day 7: 0.93±1.03 vs. 5.3±2.58, P<0.01; day 14: 0.28±0.53 vs. 4.06±2.58, P<0.01). Early complication rates were lower in the prepectoral group (3.45% vs. 23.3%), although this difference did not reach statistical significance (P=0.056). Baseline imbalances (prior radiotherapy: 11.1% vs. 34.5%, P=0.049) were documented and considered in interpretation.Conclusions: Prepectoral breast reconstruction with ADM is associated with significantly reduced postoperative pain compared to subpectoral reconstruction, along with a trend toward lower early complication rates. However, given the non-randomized design, baseline imbalances, and limited sample size, these findings should be interpreted with caution and considered hypothesis-generating.
Source: Gland Surgery
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223912342