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

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  • Breast Surgery
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Abstract

Introduction

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.

Results

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).

Conclusion

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

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Reference

  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. https://doi.org/10.23750/abm.v92i3.9916

    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 

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

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Correspondence to Neta Adler.

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

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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). https://doi.org/10.1007/s00266-022-03136-7

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  • DOI: https://doi.org/10.1007/s00266-022-03136-7

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