Skip to main content


Log in

Revision Rate of Direct-to-Implant Breast Reconstruction: Is it Truly a Single-Stage Reconstruction? A Single-Surgeon Experience

  • Original Article
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript



There has been increased interest in direct-to-implant (DTI) reconstruction in recent years. The goal of this study was to focus on the re-operation rate of DTI in comparison with two-stage tissue expander (TE) reconstruction.

Patients and Methods

In total, 165 consecutive patients (222 breasts) underwent skin sparing mastectomy and immediate implant-based reconstruction between January 2010 and December 2019. Patients were divided to TE procedure and DTI (42,180 breasts, respectively).

Data collected included demographics, operative details and oncological medical treatment, complications classified according to Clavien–Dindo, capsular contracture Baker 3-4 and re-operation due to complication or due to patient’s wish to improve aesthetic appearance.


There were significantly more prophylactic mastectomies and BRCA gene mutation in the DTI breast reconstruction group, and more smokers and diabetic patients in the TE group.

No significant difference was found in the complication rates between the groups (DTI—26.1%, TE—40.5%). However, major complication and re-operation rate due to complications were significantly different ( DTI—16.7% and 10.6%, TE—26.2% and 31%, respectively, p= 0.035, p = 0.008). No significant differences were found in Clavien–Dindo stages between the groups except for Grade 3b.

Re-operation due to desire for aesthetic improvement was significantly higher in the TE group (DTI—38%. TE—69%, p=0.0003).


DTI immediate breast reconstruction can provide a good alternative to the traditional two-stage TE/implant operation. Both patients and surgeons can be reassured that the majority of the cases are one-stage reconstruction.

Level of Evidence IV

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Panchal H, Matros E (2017) Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg 140:7S-13S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kamali P, Koolen PGL, Ibrahim AMS, Paul MA, Dikmans RE, Schermerhorn ML et al (2016) Analyzing regional differences over a 15-year trend of one-stage versus two-stage breast reconstruction in 941,191 postmastectomy patients. Plast Reconstr Surg 138(1):1e–14e

    Article  CAS  PubMed  Google Scholar 

  3. Krishnan NM, Fischer JP, Basta MN, Nahabedian MY (2016) Is single-stage prosthetic reconstruction cost effective? a cost-utility analysis for the use of direct-to-implant breast reconstruction relative to expander-implant reconstruction in postmastectomy patients. Plast Reconstr Surg 138(3):537–547

    Article  CAS  PubMed  Google Scholar 

  4. Basta MN, Gerety PA, Serletti JM, Kovach SJ, Fischer JP (2015) A systematic review and head-to-head meta-analysis of outcomes following direct-to-implant versus conventional two-stage implant reconstruction. Plast Reconstr Surg 136(6):1135–1144

    Article  CAS  PubMed  Google Scholar 

  5. Gao P, Bai P, Ren Y, Kong X, Wang Z, Fang Y et al (2021) Biological matrix-assisted one-stage implant-based breast reconstruction versus two-stage implant-based breast reconstruction: patient-reported outcomes and complications. Aesthet Plast Surg 45(6):2581–2590

    Article  Google Scholar 

  6. Innocenti A, Melita D, Affortunati M, Susini T, Innocenti M (2021) Immediate-implant-based breast reconstruction with two-stage expander implant reconstruction versus one-stage-reconstruction with acellular dermal matrix analysis of patients’ satisfaction. Acta Biomed.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dikmans REG, Negenborn VL, Bouman MB, Winters HAH, Twisk JWR, Ruhé PQ et al (2017) Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol 18(2):251–258

    Article  PubMed  Google Scholar 

  8. Brunbjerg ME, Jensen TB, Overgaard J, Christiansen P, Damsgaard TE (2021) Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction-a cohort study. Gland Surg 10(1):207–218

    Article  PubMed  PubMed Central  Google Scholar 

  9. Caputo GG, Vigato E, Rampino Cordaro E, Parodi PC, Governa M (2021) Comparative study of patient outcomes between direct to implant and two-stage implant-based breast reconstruction after mastectomy. J Plast Reconstr Aesthet Surg 74(10):2573–2579

    Article  PubMed  Google Scholar 

  10. Dimovska EOF, Chen C, Chou HH, Lin YL, Cheng MH (2021) Outcomes and quality of life in immediate one-stage versus two-stage breast reconstructions without an acellular dermal matrix: 17- years of experience. J Surg Oncol 124(4):510–520

    Article  PubMed  Google Scholar 

Download references


None of the authors has a financial interest in any of the products, devices or drugs mentioned in this manuscript

Author information

Authors and Affiliations


Corresponding author

Correspondence to Neta Adler.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

The study received permission from the hospital ethical committee (HMO- 0065-22)

Informed Consent

For this type of study, informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adler, N., Carmon, E. & Houri, P. Revision Rate of Direct-to-Implant Breast Reconstruction: Is it Truly a Single-Stage Reconstruction? A Single-Surgeon Experience. Aesth Plast Surg 47, 1707–1712 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: