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Risk Stratification in Subpectoral to Prepectoral Pocket Conversion to Reduce Post-reconstruction Animation Deformity
Jaclyn Riana Cerceo1, Lawrence Veeravagu2, Pooja Yesantharao3, Rahim Nazerali4, Brian Thornton5 1 University of Nevada, Reno School of Medicine, Reno, NV 2 Stanford University, Division of Plastic Surgery, Palo Alto, CA 3 Johns Hopkins University School of Medicine, Baltimore, MD 4 Stanford University, Division of Plastic Surgery, Palo Alto, CA 5 ThorntonMD Plastic Surgery, Louisville, KY

Background: Animation deformity is a morbid complication that impacts women who undergo subpectoral implant-based breast reconstruction resulting in pain, increased asymmetry, and poor aesthetic outcome. Pocket conversion involving the transfer of implants from the subpectoral to prepectoral space, can be performed to minimize this issue. While prior literature has evaluated outcomes associated with this procedure, we desired to elucidate the risk factors most commonly associated with postoperative complications following pocket conversion.

Methods: We performed a retrospective cohort investigation of 34 women (63 breasts) undergoing pocket conversion to the pre-pectoral space. Pre-conversion clinical characteristics and surgical complications (major and minor) were collected. Predictors for postoperative complications among pocket conversion patients were identified using univariate and multivariate logistic regression models. Odds ratios (OR) and adjusted odds ratios (aOR) are presented with 95% confidence intervals, and p-values were assessed at α = 0.05 in all cases.

Results: A total of 34 patients (63 breasts) were included in the study. Pocket conversion relieved animation deformity in all 63 breasts. The overall rates of major and minor complications were 14.3% (n= 9/63) and 34.9% (n= 22/63), respectively. After adjusting for confounders, duration of implant placement (OR=1.35, CI= 1.07-1.78; aOR= 1.1, CI= 1.00-1.21) and implant rupture (OR= 6.00, CI= 0.99-34.58; aOR= 12.8, CI= 1.15-170.32) prior to pocket conversion were found to be significant predictors of major postoperative complications. Surprisingly however, body mass index (BMI) and smoking status were not found to be predictors for postoperative complications.

Conclusion: With a fairly inclusive patient population, this series provides data for improved risk stratification of patients considering pocket conversion to relieve animation deformity. Interestingly, traditional patient risk factors (namely BMI and smoking status) were not significant predictors for postoperative complications, suggesting that this procedure may be safe even in high-risk patients. Such data serves to support more informed preoperative patient counseling and the wider application of this procedure among increasingly diverse patient populations.

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