Surgical outcomes and quality of life status after implant pocket conversion from subpectoral to pre-pectoral breast reconstruction

Abstract Background Subpectoral implant-based breast reconstruction is associated with complications such as animation deformity, chronic pain, and aesthetic dissatisfaction, significantly affecting patient quality of life (QOL). Prepectoral pocket conversion has emerged as an alternative to address these issues, particularly for patients with complications from prior subpectoral reconstruction. Despite its increasing use, limited data exist on the impact of this technique on patient-reported outcomes, including satisfaction and QOL. This study aimed to evaluate the outcomes of prepectoral pocket conversion, focusing on complications, aesthetic results, and patient-reported QOL improvements, using the BREAST-Q questionnaire. Methods This is a retrospective cohort study, conducted on 37 patients (60 breasts) who underwent prepectoral pocket conversion between January 2018 and March 2024. Demographic, clinical, surgical, and postoperative data were collected. BREAST-Q scores were compared pre- and post-conversion. Results Patients had a mean age of 53 years, with a median follow-up of 622 days (1 year and 8 months). Indications for conversion included capsular contracture (21.3%) and animation deformity (17.5%). Complications were minimal, with 1.7% hematoma and 6.7% capsular contracture. Significant improvements were observed in BREAST-Q scores for breast satisfaction ( P = 0.002), physical well-being ( P = 0.037), and sexual well-being ( P = 0.019). Fat grafting was required in 16.7% of cases to enhance aesthetic outcomes. Conclusions Prepectoral pocket conversion is a safe and effective procedure that alleviates complications of subpectoral reconstruction, improves aesthetic outcomes, and enhances patient satisfaction and QOL. Further prospective studies with larger cohorts are warranted. Level of Evidence: Level III, risk / prognostic study.