Selective Pectoralis Muscle Denervation Reduces Capsular Contracture in Sub-Pectoral Breast Reconstruction. Long-Term Retrospective Case- Control Study

Background: Implant-based breast reconstruction (IBBR) is the most common method of breast reconstruction globally. Although the traditional approach places implants in a retropectoral position, pre-pectoral reconstruction has recently gained popularity due to its improved aesthetic outcomes and lower capsular contracture (CC) rates. However, not all patients are ideal candidates for prepectoral IBBR, making the retropectoral technique still a valuable option. Capsular contracture is a common complication of IBBR, causing discomfort, pain, poor cosmetic results, and often necessitating revision surgery, particularly in retropectoral cases. Selective denervation of the pectoralis major muscle (PMM) in retropectoral IBBR is a novel technique to reduce these complications. Material and Methods: We selected a group of denervated retro-pec IBBR patients and compared them to non-denervated patients. In a previous study, we analyzed the subjective opinions on the reconstruction outcomes using the BREAST-Q postoperative questionnaire. At the same time, we compared retrospectivally the same groups, with a minimum 24-month follow-up, from an objective perspective, evaluating CC rates by Baker scale and possible implant malrotation through outpatient clinic visits performed by three independent breast cancer professionals. Results: The overall mean follow-up was 3.33 (±0.47) years, and the CC rate was significantly lower in Group 1, even adjusting for the propensity score. Conclusions: PMM selective denervation has gained statistical appreciation by women and significantly reduced the CC rate from an objective evaluation in the setting of retro-pectoral IBBR in our series.