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Peer-reviewedCC BY-NC-NDGland surgery

Two-stage breast reconstruction comparison between prepectoral tissue expander wrapped within acellular dermal matrix versus subpectoral placement: the prospective observational EX-BRAX study.

  • Marco Bernini1
  • Alessandro Ammar2
  • Matteo Enrico Sobrero1
  • Chiara Melchiorri1
  • Chiara Gelati2
  • Federico Giorgini2
  • Riccardo Villani2
  • Daniela Tassone2
  • Marco Di Bert2
  • Simone Zanotti1
  • Alice Pellegrini1
  • Margherita Serra1
3 more authors
  • Marica Melina1
  • Giangaspare Mineo3
  • Federico Contedini2
  1. 1Breast Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  2. 2Plastic Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  3. 3U.O. Radiologia Senologica Interaziendale Ausl Bologna-IRCCS Policlinico S. Orsola, Bologna, Italy.
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Abstract

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. 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. 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. 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.

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Cite

BibTeXRIS
BibTeX
@article{bernini2026twostage,
  title = {{Two-stage breast reconstruction comparison between prepectoral tissue expander wrapped within acellular dermal matrix versus subpectoral placement: the prospective observational EX-BRAX study.}},
  author = {Marco Bernini and Alessandro Ammar and Matteo Enrico Sobrero and Chiara Melchiorri and Chiara Gelati and Federico Giorgini and Riccardo Villani and Daniela Tassone and Marco Di Bert and Simone Zanotti and Alice Pellegrini and Margherita Serra and Marica Melina and Giangaspare Mineo and Federico Contedini},
  journal = {Gland surgery},
  year = {2026},
  month = sep,
  doi = {10.21037/gs-2026-0328},
  url = {https://europepmc.org/article/MED/42996847},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Two-stage breast reconstruction comparison between prepectoral tissue expander wrapped within acellular dermal matrix versus subpectoral placement: the prospective observational EX-BRAX study.
AU  - Marco Bernini
AU  - Alessandro Ammar
AU  - Matteo Enrico Sobrero
AU  - Chiara Melchiorri
AU  - Chiara Gelati
AU  - Federico Giorgini
AU  - Riccardo Villani
AU  - Daniela Tassone
AU  - Marco Di Bert
AU  - Simone Zanotti
AU  - Alice Pellegrini
AU  - Margherita Serra
AU  - Marica Melina
AU  - Giangaspare Mineo
AU  - Federico Contedini
PY  - 2026
DA  - 2026/09/28
JO  - Gland surgery
DO  - 10.21037/gs-2026-0328
UR  - https://europepmc.org/article/MED/42996847
AB  - 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. 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. 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. 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.
SN  - 2227-684X
SN  - 2227-8575
ER  -