Shaped versus Round Implants in Breast Reconstruction: A Multi-Institutional Comparison of Surgical and Patient-Reported Outcomes

Abstract

Background Since the 2012 approval of shaped implants, their use in breast reconstruction has increased in the United States. However, large-scale comparisons of complications and patient-reported outcomes are lacking. The authors endeavored to compare surgical and patient-reported outcomes across implant types. Methods The Mastectomy Reconstruction Outcomes Consortium database was queried for expander/implant reconstructions with at least 1-year post-exchange follow-up (mean, 18.5 months). Outcomes of interest included postoperative complications, 1-year revisions, and patient-reported outcomes. Bivariate and mixed-effects regression analyses evaluated the effect of implant type on patient outcomes. Results Overall, 822 patients (73.5 percent) received round and 297 patients (26.5 percent) received shaped implants. Patients undergoing unilateral reconstructions with round implants underwent more contralateral symmetry procedures, including augmentations (round, 18.7 percent; shaped, 6.8 percent; p = 0.003) and reductions (round, 32.2 percent; shaped, 20.5 percent; p = 0.019). Shaped implants were associated with higher rates of infection (shaped, 6.1 percent; round, 2.3 percent; p = 0.002), that remained significant after multivariable adjustment. Other complication rates did not differ significantly between cohorts. Round and shaped implants experienced similar 2-year patient-reported outcome scores. Conclusions This prospective, multicenter study is the largest evaluating outcomes of shaped versus round implants in breast reconstruction. Although recipients of round implants demonstrated lower infection rates compared with shaped implants, these patients were more likely to undergo contralateral symmetry procedures. Both implant types yielded comparable patient-reported outcome scores. With appropriate patient selection, both shaped and round implants can provide acceptable outcomes in breast reconstruction. Clinical Question/Level of Evidence Therapeutic, III.

Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction

“…Therefore, the patient’s decision to undergo secondary surgery is multifactorial and complex, which may be influenced by patient factors, 17 healthcare settings, 30 and surgical practice. 31 , 32 …”

Analyse implantatbasierter, netzunterstützter, plastisch-rekonstruktiver Mammaoperationen

“…Patientinnen die Brust als geschmeidiger (Nahabedian, 2014). Während sich keine wesentlichen Unterschiede hinsichtlich der Gesamtkomplikationsrate (Macadam et al, 2013;Nahabedian, 2014) sowie Patientenzufriedenheit (Macadam et al, 2013;Khavanin et al, 2017) zwischen beiden Implantatformen zeigen, gibt es Hinweise auf eine geringere Rate an postoperativen Infektionen zugunsten der runden Implantate (Khavanin et al, 2017).…”

Breast Implant Surfaces and Their Impact on Current Practices: Where We Are Now and Where Are We Going?

“…7,13,14 Textured implants have demonstrated a 3 times higher infection rate over comparable smooth implants in a prospective series. 15 Studies have associated biofilms with breast implant complications including CC 16,17 and double-capsule formation. 18 More recently, the infectious theory related to bacterial contamination has been implicated as a potential etiology for breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL).…”