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This retrospective monocentric study included patients treated with implant-based reconstruction at a breast unit in Rome from January 2014 to March 2024, comparing pre-pectoral versus sub-pectoral approaches. Among 622 patients, overall complication rates were similar, and reconstruction technique was not linked to delays. 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Breast Cancer Patients Undergoing Implant-Based Reconstructions: Pre-Pectoral Versus Sub-Pectoral  \nGianluca Vanni 1, Marco Pellicciaro 1,2, *, Marco Materazzo 1,2, Alice Bertolo 1, Amir Sadri 3, Elisa Campanella 1, Denisa Eskiu 4, Ilaria Portarena 5, Benedetto Longo 6, Valerio Cervelli 6  \nand Oreste Claudio Buonomo 1,7  \nAcademic Editors: Jonas Cicenas and Mary J.C. Hendrix  \nReceived: 11 November 2025  \nRevised: 21 December 2025  \nAccepted: 25 December 2025  \nPublished: 29 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy; [mrcmaterazzo@gmail.com](mrcmaterazzo@gmail.com) (M.M.)  \n2 PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, 00133 Rome, Italy  \n3 Plastic Surgery, Great Ormond Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK  \n4 Faculty of Medicine, Università Cattolica Nostra Signora Del Buon Consiglio, 1001 Tirana, Albania; [d.eskiu@prof.unizkm.al](d.eskiu@prof.unizkm.al)  \n5 Department of Oncology, Tor Vergata Hospital, 00133 Rome, Italy  \n6 Plastic and Reconstructive Surgery, Department of Surgical Science, Tor Vergata University, 00133 Rome, Italy  \n7 Department of Health Science, University of Basilicata, Via Nazario Sauro, 85, 85100 Potenza, Italy  \n* [Correspondence: marcopell62@gmail.com](Correspondence: marcopell62@gmail.com); Tel.: +39-328-0221779  \nSimple Summary  \nMastectomy is undoubtedly a highly invasive procedure and has a serious psychological and physical impact on patients. The introduction of pre-pectoral reconstruction has led to an increase in immediate breast reconstructions, improving patients’ quality of life and reducing surgical morbidity, as there is no need to create a sub-pectoral pocket. Although these advantages are well established, some authors have reported a higher risk of implant-related complications. These complications could potentially delay the initiation of adjuvant treatments, which is well known to negatively affect oncologic outcomes. In our study, we compared pre-pectoral and sub-pectoral reconstructions and found no statistically significant differences in the time to adjuvant treatment. Therefore, given its lower surgical impact, the pre-pectoral approach should be considered the preferred option whenever feasible in patients undergoing mastectomy for breast cancer.  \nAbstract  \nBackground: Immediate breast reconstruction after mastectomy has progressively shifted toward less invasive approaches. The pre-pectoral approach, avoiding muscle dissection, may reduce post-operative pain, surgical trauma, and recovery time. However, concerns regarding surgical complications and their potential impact on the timing of adjuvant treatments still persist. Methods: A retrospective monocentric study was conducted, including all patients who underwent mastectomy with implant-based breast reconstruction at the Breast Unit of Policlinico Tor Vergata in Rome between January 2014 and March 2024 . Patients were classified according to the reconstructive technique as either pre-pectoral or sub-pectoral. Demographic, oncologic, and surgical data were collected and analyzed, with a particular focus on post-operative complications and the timing of adjuvant treatment initiation. Results: Of 622 patients, 366 (58.9%) underwent sub-pectoral reconstruction and 235 (37.7%) pre-pectoral. Overall, the complication rates were comparable between the two reconstructions (23.8% vs. 20.2%, p = 0.310) . Delayed wound healing was higher in the pre-pectoral group (9.0% vs. 4.3%, p = 0.035), whereas post-operative bleeding occurred  \nmore often in sub-pecto","cbCaiuFQ3Th1vPTU","https://ap.wps.com/l/cbCaiuFQ3Th1vPTU","pdf",1103108,13,"English","# Simple Summary\n# Abstract\n## Background\n## Methods\n## Results\n## Keywords\n# 1. Introduction","[{\"question\":\"What comparison does the study make in breast reconstruction timing?\",\"answer\":\"It compares pre-pectoral versus sub-pectoral implant-based reconstructions and evaluates whether post-operative complications influence the time to initiation of adjuvant treatment.\"},{\"question\":\"What did the study find about overall complication rates?\",\"answer\":\"Overall complication rates were comparable between the two reconstruction techniques, with no statistically significant difference reported.\"},{\"question\":\"Which factors predicted delayed initiation of adjuvant therapy?\",\"answer\":\"Multivariate analysis identified skin-reducing mastectomy, smoking, and diabetes mellitus as predictors of delayed adjuvant therapy, while the reconstruction technique itself was not associated with delays.\"}]","Post-Operative Complications Do Not Influence Time to Adjuvant Treatment in Breast Cancer Patients Undergoing Implant-Based Reconstructions - Pre-Pectoral Versus Sub-Pectoral | PDF",1790768501,33]