Subpectoral to prepectoral pocket change in implant-based breast reconstruction: A retrospective cohort study at a single institution.

[BACKGROUND] Patients who underwent breast reconstruction with submuscular implants frequently experience animation deformity (AD), pain, and cosmetic issues, warranting consideration of implant removal, exchange, pocket change, or autologous reconstruction. Advances in prepectoral reconstruction have prompted several patients to undergo transfer of their implants from a submuscular to prepectoral pocket ("pocket change").

[METHODS] We conducted a single-center, retrospective review analyzing all patients with post-mastectomy submuscular implant-based reconstruction who underwent pocket change procedures from 2014 to 2023.

[RESULTS] Procedures on 275 breasts in 153 patients met the inclusion criteria. Reasons for pursuing surgery included pain or discomfort (173 procedures, 63%), AD (158, 57%), non-AD cosmetic issues (92, 33%), muscle spasm (84, 31%), capsular contracture (68, 25%), and implant rupture (44, 16%). In 45 cases (16%), the procedure was staged using prepectoral tissue expanders. Mesh was used in 194 procedures (71%). Mean length of postoperative follow-up was 2.54 years. Complications included 7 seromas (2.5%), 1 hematoma (0.4%), 10 infections (3.6%), and 7 hospitalizations within 30 days of surgery (2.5%). In 6 patients (2.2%), the prepectoral implant was removed within 1 year of surgery-due to 5 infections and 1 capsular contracture. Ten cases (3.6%) of capsular contracture were reported. AD was resolved in all affected patients. Finally, 82 patients reported pain outcomes within 60 days of their unilateral or bilateral procedure, with 75 (91%) experiencing resolved or significantly improved pain.

[CONCLUSIONS] A pocket change procedure is an effective intervention to treat complications associated with submuscular implant reconstruction. Further study is warranted to evaluate long-term aesthetic and patient satisfaction outcomes.