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One-staged vs Two-staged Breast Reconstruction: Outcomes and Patient Satisfaction
Vidya Shankaran, M.D.
Steven Schulz, M.D.
John Pedersen, M.D.
Douglas Wagner, M.D.
Summa Health System, Akron, OH
2014-03-14
Presenter: Vidya Shankaran/Steven Schulz (one of the two - depending on whether other abstract accepted)
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Please make a statement as to how much of the above work represents the original work of the resident.
Director Name: Douglas Wagner, M.D.
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
One-staged (direct-to-implant), prosthetic breast reconstruction has become increasingly common amongst both patients and plastic surgeons, likely due to increased numbers of prophylactic mastectomies and improved techniques for both mastectomy and reconstruction. The goal of this preliminary study is to compare outcomes of direct-to-implant and expander/implant reconstruction. Patient satisfaction with both reconstructive methods will then be compared through the BREAST-Q©, a validated, patient-reported survey.
Methods
In this retrospective review, 92 consecutive patients (41 direct-to-implant, 51 expander/implant) were analyzed. Data points compared include surgical indications/methods, reconstruction timing, and complications such as antibiotic treatment, seroma aspiration, wound dehiscence, and re-operation. The BREAST-Q© was administered to each patient to determine satisfaction with the reconstruction process.
Results
The groups were comparable in their body mass index (27.5 and 26.2, p=0.306), rates of diabetes (7.3% and 5.9%, p=0.782), and smoking (14.6% and 25.5%, p=0.201). A higher percentage of direct-to-implant patients underwent immediate reconstruction (90.2% vs. 64.7%, p=0.004). The overall complication rate between both groups was similar (53.7% and 41.2%, p=0.233), and the percentage of patient warranting surgical revision was nearly identical (32.5% vs 31.3%, p=0.900). The number of total operations per patient was lower in the one-staged group (1.7 vs 2.8, p<0.001).
Conclusions
This analysis demonstrates that complication rates and complexity are similar in both reconstruction methods. This finding contrasts the perception by patients and many physicians that direct-to-implant reconstruction is a more straightforward route of reconstruction. The second part of this analysis, the BREAST-Q©, will likely reflect this disconnect between patient expectations and outcomes.
