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Immediate Breast Reconstruction after Mastectomy: Tissue Expander versus Direct to Implant?
Stephen Lopez MD
Nirvana Saraswat MS
Douglas Wagner MD
Summa Akron Ohio Plastic Surgery program
2016-01-31
Presenter: Stephen Lopez
Affidavit:
Stephen Lopez is first author and has contributed to >90% of the research material presented.
Director Name: Douglas Wagner MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: With increasing popularity in immediate breast reconstruction, there is little literature comparing the traditional two-stage tissue expander (TE) reconstruction with the more recent direct to implant (DTI) reconstruction. This study seeks to compare the two reconstruction methods in terms of complications and aesthetic revision rates.
Material and Methods: Retrospective analysis of 196 breasts by a single surgeon from 2010-2014 was performed. Comparison of the reconstruction methods and risk stratification were performed via Student's t-test/Pearson chi-square, or Fisher's exact test. Complications and aesthetic revision rates were compared.
Results: 119 charts were reviewed over a 4-year period with a mean follow up of 14.7 months. Mean BMI was 27.1. Majority of the reconstructions were performed for Stage 0 cancer or prophylaxis (n=196, 69.9%). A significant difference in complication rates were noted in TE vs. DTI reconstruction (40.5% v. 28.2 respectively; p = 0.037). Infection rates were shown to be significantly higher in the TE group (34.2% v. 13.7%, p = 0.0022). There was no difference in rates of seroma, hematoma, mastectomy skin flap necrosis, or aesthetic revisions. Risk stratification showed higher complication rates in each group with patients with higher BMI (>40, p < 0.005), smoking (within 3 months of reconstruction; p < 0.04093) and postoperative radiation (p < 0.027).
Conclusion: Immediate tissue expander reconstruction was shown to lead to higher infection rates. Patients with higher BMIs, current smokers or those we anticipate the need for postoperative radiation should be considered for delayed reconstruction.
