Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study. Issue 5 (November 2017)

• Record Type: Journal Article
• Authors: Srinivasa, Dhivya R.; Garvey, Patrick B.; Qi, Ji; Hamill, Jennifer B.; Kim, Hyungjin M.; Pusic, Andrea L.; Kronowitz, Steven J.; Wilkins, Edwin G.; Butler, Charles E.; Clemens, Mark W.
• Is Part Of: Plastic and reconstructive surgery. Volume 140:Issue 5(2017:Nov.)
• Publication Date: 2017-11
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000003748
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: Direct-to-implant breast reconstruction offers time-saving advantages over two-stage techniques. However, use of direct-to-implant reconstruction remains limited, in part, because of concerns over complication rates.1, 2 The authors' aim was to compare 2-year complications and patient-reported outcomes for direct-to-implant versus tissue expander/implant reconstruction. Methods: Patients undergoing immediate direct-to-implant or tissue expander/implant reconstruction were enrolled in the Mastectomy Reconstruction Outcomes Consortium, an 11-center prospective cohort study. Complications and patient-reported outcomes (using the BREAST-Q questionnaire) were evaluated. Outcomes were compared using mixed-effects regression models, adjusting for demographic and clinical characteristics. Results: Of 1427 patients, 99 underwent direct-to-implant reconstruction and 1328 underwent tissue expander/implant reconstruction. Two years after reconstruction and controlling for covariates, direct-to-implant and tissue expander/implant reconstruction patients did not show statistically significant differences in any complications, including infection. Multivariable analyses found no significant differences between the two groups in patient-reported outcomes, with the exception of sexual well-being, where direct-to-implant patients fared better than the tissue expander/implant cohort ( p = 0.047). Conclusions: This prospective, multi-institutional study showed no statistically significant differences between direct-to-implant and tissue expander/implant reconstruction, in either complication rates or most patient-reported outcomes at 2 years postoperatively. Direct-to-implant reconstruction appears to be a viable alternative to expander/implant reconstruction. This analysis provides new evidence on which to base reconstructive decisions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II. Abstract : Video Discussion by Neil A. Fine, M.D., is Available Online for this Article.