Aesthetic Plastic Surgery

, Volume 43, Issue 4, pp 890–898 | Cite as

Complications Following Subpectoral Versus Prepectoral Breast Augmentation: A Meta-analysis

  • Shangshan Li
  • Dali Mu
  • Chunjun Liu
  • Minqiang Xin
  • Su Fu
  • Boyang Xu
  • Zifei Li
  • Jun Qi
  • Jie LuanEmail author
Original Article Breast Surgery



Subpectoral and prepectoral planes have commonly been used in implant-based breast augmentation. The effect of implant plane on complication rate was still unclear. This meta-analysis demonstrated current evidence with regard to comparison of complication rates between subpectoral and prepectoral breast augmentation.


Pubmed, EMBASE and Cochrane library were searched to December 2018. The results of selected studies were meta-analyzed to obtain a pooled odds ratio of the effect of subpectoral versus prepectoral breast augmentation on rates of complications.


There were significantly lower rates of capsular contracture and hematoma but higher rates of implant displacement and animation deformity in the subpectoral group compared with the prepectoral group. There was no significant difference with regard to rates of reoperation, seroma, rippling, infection and implant rupture between these two groups.


Subpectoral and subglandular breast augmentations both have their merits and demerits with regard to complications. The pros and cons of each procedure should be fully explained to patients and selection of implant plane should be considered more comprehensively.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Subpectoral Prepectoral Breast augmentation Complication 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose. No funding was aided for this study.

Ethical Approval

All analyses were based on previous published studies thus ethical approval is unnecessary.

Informed Consent

This study was based on previous published studies that informed consent was unnecessary.


  1. 1.
    Tebbetts JB, Adams WP (2005) Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg 116:2005–2016Google Scholar
  2. 2.
    McGuire P, Reisman NR, Murphy DK (2017) Risk factor analysis for capsular contracture, malposition, and late seroma in subjects receiving natrelle 410 form-stable silicone breast implants. Plast Reconstr Surg 139:1–9. CrossRefGoogle Scholar
  3. 3.
    Spear SL, Murphy DK, Allergan Silicone Breast Implant U.S. Core Clinical Study Group (2014) Natrelle round silicone breast implants: core study results at 10 years. Plast Reconstr Surg 133:1354–1361. CrossRefGoogle Scholar
  4. 4.
    Stevens WG, Nahabedian MY, Calobrace MB et al (2013) Risk factor analysis for capsular contracture: a 5-year Sientra study analysis using round, smooth, and textured implants for breast augmentation. Plast Reconstr Surg 132:1115–1123. CrossRefGoogle Scholar
  5. 5.
    Benito-Ruiz J, Manzano ML, Salvador-Miranda L (2017) Five-year outcomes of breast augmentation with form-stable implants: periareolar vs transaxillary. Aesthet Surg J 37:46–56. CrossRefGoogle Scholar
  6. 6.
    Shi H, Cao C, Li X et al (2015) A retrospective study of primary breast augmentation: recovery period, complications and patient satisfaction. Int J Clin Exp Med 8:18737–18743Google Scholar
  7. 7.
    Khan UD (2013) Muscle-splitting, subglandular, and partial submuscular augmentation mammoplasties: a 12-year retrospective analysis of 2026 primary cases. Aesthet Plast Surg 37:290–302. CrossRefGoogle Scholar
  8. 8.
    Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefGoogle Scholar
  9. 9.
    Calobrace MB, Stevens WG, Capizzi PJ et al (2018) Risk factor analysis for capsular contracture: a 10-year sientra study using round, smooth, and textured implants for breast augmentation. Plast Reconstr Surg 141:20S–28S. CrossRefGoogle Scholar
  10. 10.
    Stutman RL, Codner M, Mahoney A et al (2012) Comparison of breast augmentation incisions and common complications. Aesthet Plast Surg 36:1096–1104. CrossRefGoogle Scholar
  11. 11.
    Pereira LH, Sterodimas A (2009) Transaxillary breast augmentation: a prospective comparison of subglandular, subfascial, and submuscular implant insertion. Aesthet Plast Surg 33:752–759. CrossRefGoogle Scholar
  12. 12.
    Seify H, Sullivan K, Hester TR (2005) Preliminary (3 years) experience with smooth wall silicone gel implants for primary breast augmentation. Ann Plast Surg 54:231–235 (discussion 235) Google Scholar
  13. 13.
    Vazquez B, Given KS, Houston GC (1987) Breast augmentation: a review of subglandular and submuscular implantation. Aesthet Plast Surg 11:101–105CrossRefGoogle Scholar
  14. 14.
    Puckett CL, Croll GH, Reichel CA et al (1987) A critical look at capsule contracture in subglandular versus subpectoral mammary augmentation. Aesthet Plast Surg 11:23–28CrossRefGoogle Scholar
  15. 15.
    Spear SL, Schwartz J, Dayan JH et al (2009) Outcome assessment of breast distortion following submuscular breast augmentation. Aesthet Plast Surg 33:44–48. CrossRefGoogle Scholar
  16. 16.
    Lentz RB, Piper ML, Gomez-Sanchez C et al (2017) Correction of breast animation deformity following prosthetic breast reconstruction. Plast Reconstr Surg 140:643e–644e. CrossRefGoogle Scholar
  17. 17.
    Hammond DC, Schmitt WP, O’Connor EA (2015) Treatment of breast animation deformity in implant-based reconstruction with pocket change to the subcutaneous position. Plast Reconstr Surg 135:1540–1544. CrossRefGoogle Scholar
  18. 18.
    Wiener TC (2008) Relationship of incision choice to capsular contracture. Aesthet Plast Surg 32:303–306. CrossRefGoogle Scholar
  19. 19.
    Del Pozo JL, Tran NV, Petty PM et al (2009) Pilot study of association of bacteria on breast implants with capsular contracture. J Clin Microbiol 47:1333–1337. CrossRefGoogle Scholar
  20. 20.
    Yalanis GC, Liu EW, Cheng HT (2015) Efficacy and safety of povidone-iodine irrigation in reducing the risk of capsular contracture in aesthetic breast augmentation: a systematic review and meta-analysis. Plast Reconstr Surg 136:687–698. CrossRefGoogle Scholar
  21. 21.
    Li S, Chen L, Liu W et al (2018) Capsular contracture rate after breast augmentation with periareolar versus other two (inframammary and transaxillary) incisions: a meta-analysis. Aesthet Plast Surg 42:32–37. CrossRefGoogle Scholar
  22. 22.
    Wong CH, Samuel M, Tan BK et al (2006) Capsular contracture in subglandular breast augmentation with textured versus smooth breast implants: a systematic review. Plast Reconstr Surg 118:1224–1236. CrossRefGoogle Scholar
  23. 23.
    Lesavoy MA, Trussler AP, Dickinson BP (2010) Difficulties with subpectoral augmentation mammaplasty and its correction: the role of subglandular site change in revision aesthetic breast surgery. Plast Reconstr Surg 125:363–371. CrossRefGoogle Scholar
  24. 24.
    Araco A, Gravante G, Araco F et al (2007) A retrospective analysis of 3,000 primary aesthetic breast augmentations: postoperative complications and associated factors. Aesthet Plast Surg 31:532–539. CrossRefGoogle Scholar
  25. 25.
    Stevens WG, Calobrace MB, Alizadeh K et al (2018) Ten-year core study data for Sientra’s Food and Drug Administration-approved round and shaped breast implants with cohesive silicone gel. Plast Reconstr Surg 141:7S–19S. CrossRefGoogle Scholar
  26. 26.
    Adams WP Jr (2008) The process of breast augmentation: four sequential steps for optimizing outcomes for patients. Plast Reconstr Surg 122:1892–1900. CrossRefGoogle Scholar
  27. 27.
    Handel N, Cordray T, Gutierrez J et al (2006) A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg 117:757–767. (discussion 768–772) CrossRefGoogle Scholar
  28. 28.
    Kerfant N, Henry AS, Hu W et al (2017) Subfascial primary breast augmentation with fat grafting: a review of 156 cases. Plast Reconstr Surg 139:1080e–1085e. CrossRefGoogle Scholar
  29. 29.
    Vidya R, Iqbal FM (2017) A guide to prepectoral breast reconstruction: a new dimension to implant-based breast reconstruction. Clin Breast Cancer 17:266–271. CrossRefGoogle Scholar
  30. 30.
    Highton L, Johnson R, Kirwan C et al (2017) Prepectoral implant-based breast reconstruction. Plastic and reconstructive surgery. Glob Open 5:e1488. Google Scholar
  31. 31.
    Pozner JN, White JB, Newman MI (2013) Use of porcine acellular dermal matrix in revisionary cosmetic breast augmentation. Aesthet Surg J 33:681–690. CrossRefGoogle Scholar
  32. 32.
    Maxwell GP, Gabriel A (2014) Acellular dermal matrix for reoperative breast augmentation. Plast Reconstr Surg 134:932–938. CrossRefGoogle Scholar
  33. 33.
    Munhoz AM, Gemperli R, Sampaio Goes JC (2015) Transaxillary subfascial augmentation mammaplasty with anatomic form-stable silicone implants. Clin Plast Surg 42:565–584. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery HospitalChinese Academy of Medical Sciences, Peking Union Medical CollegeBeijingChina

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