Long-Term Clinical Outcomes and Cost-Utility Analysis of Prepectoral Versus Subpectoral Implant-Based Breast…

Cohort studyClinical breast cancer· Aug 2026

Long-Term Clinical Outcomes and Cost-Utility Analysis of Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Multicenter Retrospective Cohort Study.

Federica Grieco, Marco Driutti, Emma Zanin … Nicola Zingaretti

Breast ReconstructionCohort studyTreatmentQ2IF 2.7

Prepectoral mesh implant reconstruction was linked to fewer reoperations than subpectoral approaches.

Long-Term Clinical Outcomes and Cost-Utility Analysis of Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Multicenter Retrospective Cohort Study.

Federica Grieco … Nicola Zingaretti

Clinical breast cancer · Aug 2026

Background

Immediate direct-to-implant (direct-to-implant) reconstruction after nipple-sparing mastectomy (nipple-sparing mastectomy) can be performed prepectorally or subpectorally, with variable use of implant-supporting mesh.

Methods

EQ-5D-5L utilities were collected prospectively; Quality-Adjusted Life Years (Quality-Adjusted Life Years) were estimated by trapezoidal integration.

n = 416 patients

Results

Only 13.95% needed reoperation with prepectoral mesh, versus 21.83%-27.08% with subpectoral techniques.

Prepectoral + mesh

13.95%

Subpectoral + mesh

27.08%

Subpectoral no mesh

21.83%

More results

Of 416 patients (501 reconstructions): prepectoral + mesh n = 215 (42.9%), subpectoral + mesh n = 144 (28.7%), subpectoral no mesh n = 142 (28.3%).

Mean observed total cost per patient: €8798.50 (prepectoral + mesh), €5235.28 (subpectoral + mesh), €3227.17 (subpectoral no mesh) (P < .001).

More results

Time-weighted mean EQ-5D-5L utilities ≈0.830 (prepectoral) versus ≈0.801 (pooled subpectoral).

Ten-year discounted base-case: incremental cost ≈€4567 and incremental cost-utility ratio (incremental cost-utility ratio) ≈€17,566/Quality-Adjusted Life Years for prepectoral versus pooled subpectoral.

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Conclusion

Prepectoral direct-to-implant with mesh was associated with fewer late complications and reoperations and higher Quality-Adjusted Life Years, at higher upfront cost; some mesh techniques showed increased early seroma/infection rates.

Long-Term Clinical Outcomes and Cost-Utility Analysis of Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Multicenter Retrospective Cohort Study.

Long-Term Clinical Outcomes and Cost-Utility Analysis of Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Multicenter Retrospective Cohort Study.

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