Immediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction: A multi-institutional comparison of short-term complications

Abstract

Prosthesis-based techniques are the predominant form of breast reconstruction worldwide, with two-stage tissue expander procedures being the most popular. In the past decade, there has been increasing interest in performing single-stage implant reconstruction immediately following mastectomy as an attempt to simplify the reconstructive course and improve psychosocial morbidity. However, there is a paucity of large-scale, multi-institutional data comparing the outcomes of these two reconstructive strategies. Patients who underwent immediate tissue expander or implant reconstruction following mastectomy from 2006-2010 were identified using standardised operation codes. Demographic information for patients, 30-day outcomes, and adverse events for each type of reconstruction were analysed and compared between groups. A total of 10,561 patients underwent immediate breast reconstruction. There were 9033 patients who underwent tissue expander placement (2752 bilateral), and 1528 patients who underwent immediate implant placement (485 bilateral). Patients who had implant placement demonstrated increased rates of overall complications (6.8% compared with 5.4%, p = 0.02) and prosthesis failure (1.4% compared with 0.8%, p = 0.04). There was no difference in the rate of any surgical site infections (3.9% compared with 3.4%, p = 0.39), reoperation (7.5% compared with 6.9%, p = 0.40), or major medical complications (1.8% compared with 1.6%, p = 0.57). Both immediate one-stage, direct-to-implant, and two-stage tissue expander reconstructions result in low rates of morbidity. One-stage reconstruction suggests a slightly higher complication rate related to prosthesis failure.

Comparison of one-stage vs two-stage prosthesis-based breast reconstruction: a systematic review and meta-analysis

“…1,5,28 In particular, the risks for implant loss and total complications were significantly higher in the one-stage group than those in the two-stage group. Davila The results of the aesthetic outcome analysis can be interpreted in the same context.…”

“…3 The other five studies did not describe the specific mastectomy types used, and they likely included cases of non-NSM. 1,4,19,23,26 Six studies compared patient demographics and operation-related characteristics between two groups. 1,[3][4][5]18,19 Of these, a study by Petersen et al 5 showed unilaterally unfavorable patient characteristics in which the one-stage group included a significantly higher rate of smokers and obese patients, which resulted in significant heterogeneity in the analysis.…”

“…Finally, 18 articles passed the full-text review and were thus included for the present analysis ( Figure 1). 1,[3][4][5]13,[16][17][18][19][20][21][22][23][24][25][26][27][28] …”

“…1 Despite some theoretical benefits of one-stage reconstruction including a decrease in the number of steps required for reconstruction and reducing accompanying morbidity, 1,3 the less aesthetic outcome and relatively high complication rate of the one-stage procedure concerns many surgeons. 4,5 Nipple-sparing mastectomy (NSM) has been used for patients with early-stage breast cancer.…”

“…Comparable outcomes from one-stage prosthesis reconstruction were observed in some studies, 4,13 whereas a significantly higher rate of complications have been reported for direct-to-implant methods in other studies. 1,5 Given that a meta-analytic methodology is very useful to synthesize and unify singular results M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 of previous studies, 14,15 a robust review of the literature by meta-analysis may be helpful to obtain a more comprehensive overview on this topic. In the present review, we compared the surgical outcomes of two prosthesis-based reconstruction methods in terms of postoperative complications, aesthetic satisfaction, and cost.…”