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Direct to Implant in the Era of Prepectoral Breast Reconstruction: An Evaluation of the National Trend in 59,313 Patients
Shahnur Ahmed, MD1*, Jackson A. Baril, MD, MBA1*, Carla Fisher, MD, MBA2, Rachel M. Danforth, MD1, Ravinder Bamba, MD1, Mary E. Lester, MD1, Aladdin H. Hassanein, MD, MMSc1
1Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN
2Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, IN
Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN
2025-01-09
Presenter: Shahnur Ahmed, MD
Affidavit:
All of the work on this project represents the original work of the resident and co-authors.
Director Name: E. Matthew Ritter
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
Post-mastectomy implant-based reconstruction may be performed either staged- with the initial tissue expander (TE) or direct-to-implant (DTI). There has been a shift in favor of prepectoral reconstruction benefitting from secondary fat grafting. The advantage of DTI is the potential for a "single stage" reconstruction. The purpose of this study is to evaluate the national trend of DTI compared reconstruction.
Methods:
The ACS NSQIP database (2010-2022) was analyzed for patients who had mastectomy (Current Procedural Terminology (CPT) 19303, 19307). Patients who underwent either immediate TE (CPT 19357) or implant reconstruction (CPT 19340) were included. Patients were divided into 2 groups: Group 1 (mastectomy with DTI) and Group 2 (mastectomy with immediate TE). Demographics and yearly case volume were recorded.
Results:
The study included 59,313 patients (Group 1 9,847 and Group 2 49,466). Smoking was present in 7.2% (of Group 1 compared to 9.9% of Group 2 (p=0.0001). The case volume for DTI reconstruction in 2010 was 9.1% (225/2474) compared to 21.4% in 2022 (1159/5427) (p=0.0001). Although, there was an insignificant volume dip in DTI in the COVID-19 year 2020 (20.2%, 1093/5412) compared to 2019 (21.6%, 1172/5413) (p=0.0626), there was a trend for the frequency of DTI increasing annually.
Conclusions:
Despite a shift in plastic surgeons performing prepectoral breast reconstruction, the national rates of direct-to-implant reconstruction have trended to increase annually. Because prepectoral reconstruction is common and DTI is becoming more frequently performed, the term "direct-to-implant" should not be used synonymously with "single stage reconstruction" as second stages may be frequent.
