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.

Authors

Federica Grieco, Marco Driutti, Emma Zanin, Eleonora Bassi, Elena Galvano, Luigi Castriotta, Stefano Ivan Coppola, Pier Camillo Parodi, Nicola Zingaretti

Published in

Clinical breast cancer. Volume 26. Issue 8. Pages 82-89. Jun 24, 2026. Epub Jun 24, 2026.

Abstract

Immediate direct-to-implant (DTI) reconstruction after nipple-sparing mastectomy (NSM) can be performed prepectorally or subpectorally, with variable use of implant-supporting mesh. We compared long-term clinical outcomes and cost-utility of 3 DTI strategies.
Consecutive adult women undergoing NSM with immediate DTI at 2 tertiary centers in northeastern Italy (January 1, 2011-Decmeber 31, 2024) were included. Cohorts: prepectoral DTI with mesh, dual-plane subpectoral DTI with mesh, and subpectoral DTI without mesh.
cumulative reconstruction-related reoperation.
early (≤ 90 days) and late (> 90 days) complications. EQ-5D-5L utilities were collected prospectively; Quality-Adjusted Life Years (QALYs) were estimated by trapezoidal integration. Hospital/provider costs were captured and standardized to 2024 €; base-case horizon 10 years with 3.5% annual discounting. Probabilistic sensitivity analysis (PSA) (10,000 iterations) quantified uncertainty.
Of 416 patients (501 reconstructions): prepectoral + mesh n = 215 (42.9%), subpectoral + mesh n = 144 (28.7%), subpectoral no mesh n = 142 (28.3%). Median follow-up 5.9 years. Cumulative reoperation: 13.95% (prepectoral + mesh), 27.08% (subpectoral + mesh), 21.83% (subpectoral no mesh) (P = .008). Mean observed total cost per patient: €8798.50 (prepectoral + mesh), €5235.28 (subpectoral + mesh), €3227.17 (subpectoral no mesh) (P < .001). 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 (ICUR) ≈€17,566/QALY for prepectoral versus pooled subpectoral. PSA: ≈68% probability prepectoral is cost-effective at €20,000/QALY.
Prepectoral DTI with mesh was associated with fewer late complications and reoperations and higher QALYs, at higher upfront cost; some mesh techniques showed increased early seroma/infection rates.

PMID:
42470725
Bibliographic data and abstract were imported from PubMed on 19 Jul 2026.

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