Optimizing Safety, Predictability, and Aesthetics in Direct to Implant Immediate Breast Reconstruction

Kalus, Ram; Swartz, Jennifer Dixon; Metzger, Sarah C.

doi:10.1097/sap.0000000000000771

Cited by 23 publications

(14 citation statements)

References 30 publications

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“…Previous investigators have analyzed outcomes for direct-to-implant and tissue expander/implant-based reconstruction, but these studies have been limited by single-center designs or relatively short lengths of follow-up. 5,17,18 By contrast, the current study is multicenter and prospective in its design, includes 2-year outcomes, and controls for site and multiple demographic and clinical variables. When controlling for these covariates, we found no statistically significant differences between the procedure types for risks of overall complication, major complication, overall infection, or major infection.…”

Section: Discussionmentioning

confidence: 99%

Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study

Srinivasa

Garvey

et al. 2017

Plastic &Amp; Reconstructive Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study

Srinivasa

Garvey

et al. 2017

Plastic &Amp; Reconstructive Surgery

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“…Moreover, evidence for the safety of ADM use in IBBR is also sparse, with contradictory results. Complication rates in published studies1, 5, 6, 7, 8 vary widely from 4·0 to 50·0 per cent. Reported complications include haematoma, seroma, infection, skin necrosis, flap or nipple ischaemia, and exposure of the ADM or implant5, 6, 7.…”

Section: Introductionmentioning

confidence: 99%

“…Complication rates in published studies1, 5, 6, 7, 8 vary widely from 4·0 to 50·0 per cent. Reported complications include haematoma, seroma, infection, skin necrosis, flap or nipple ischaemia, and exposure of the ADM or implant5, 6, 7. Several factors have been reported to increase the risk of complications, including age, smoking, BMI exceeding 30 kg/m 2 , periareolar incision, mastectomy weight over 600 g, and implant size larger than 600 ml5, 7, 9.…”

Section: Introductionmentioning

confidence: 99%

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Negenborn

Dikmans

Bouman

et al. 2018

British Journal of Surgery

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BackgroundIn the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct‐to‐implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two‐stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM‐assisted breast reconstruction.MethodsData were obtained from the BRIOS study, including all patients treated with DTI ADM‐assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.ResultsFifty‐nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.ConclusionBreast size appeared to be the most significant predictor of complications in DTI ADM‐assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).

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“…Limitations to this study include the lack of other determinants of immediate breast construction such as insurance status and patients’ cost, which may influence Chinese women to receive IBR. Secondly, the database does not account for the more subjective patient variables such as aesthetic outcomes with reconstruction, which could affect the treatment choice of patients with BC . Thirdly, we are comparing two different modalities of IBR with inherently different patient selection bias, and the small number of the free flaps makes the autologous cohort heterogeneous.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, the database does not account for the more subjective patient variables such as aesthetic outcomes with reconstruction, which could affect the treatment choice of patients with BC. 20 Thirdly, we are comparing two different modalities of IBR with inherently different patient selection bias, 9 and the small number of the free flaps makes the autologous cohort heterogeneous. Fourthly, we just focused on surgical complications rather than medical complications, including cardiac arrest, pneumonia, renal insufficiency and so on, which may guide the patients in decision making to undergo IBR.…”

Section: Discussionmentioning

confidence: 99%

Comparison of surgical complication between immediate implant and autologous breast reconstruction after mastectomy: A multicenter study of 426 cases

Sun

Zhang

et al. 2018

Journal of Surgical Oncology

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Background and Objectives: There is a lack of multicenter immediate breast reconstruction data comparing the surgical complication of implant and autologous breast reconstruction, especially in China. In this study, we used the data from eight centers to study the complications and their risk factors in this population. Methods: Sociodemographic and clinicopathological data were obtained and compared for patients who received immediate implant and autologous breast reconstruction after breast cancer surgery in the eight hospitals between 2012 and 2016. Logistic regression analysis was used to identify risk factors associated with the complication of breast reconstruction. Results: Immediate autologous reconstruction (IAR) was associated with significantly higher rates of overall complications (P = 0.036), fat liquefaction (P < 0.001), and reconstructive failure (P = 0.019), but lower rates of wound complications (P = 0.01) compared with the immediate implant reconstruction (IIR) at the median follow‐up time of 13.6 months. With the logistic regression analysis, older patient (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.15‐4.28; P = 0.017), and obesity (OR, 2.17; 95% CI, 1.08‐4.37; P = 0.030) were significant predictors of increased complications. Conclusion: Our multicenter results demonstrated that the rates of overall complications and reconstruction failure were higher after IAR than IIR. These findings can be used to better help surgeons and their patients with objective and reliable information to assist in selecting the modality of reconstruction.

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Optimizing Safety, Predictability, and Aesthetics in Direct to Implant Immediate Breast Reconstruction

Cited by 23 publications

References 30 publications

Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study

Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Comparison of surgical complication between immediate implant and autologous breast reconstruction after mastectomy: A multicenter study of 426 cases

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