Revisions in Implant-based Breast Reconstruction: How Does Direct-to-Implant Measure Up?
Amy S. Colwell, MD, Emily M. Clarke-Pearson, MD, Alex Lin, MS, Catherine Hertl, MD, William G. Austen, MD.
Massachusetts General Hospital, Boston, MA, USA.
Purpose: Immediate direct-to-implant breast reconstruction is increasingly performed following mastectomy for breast cancer treatment or prevention. The advantage over traditional tissue expander-implant reconstruction includes the potential for fewer surgical procedures.
Methods: Retrospective single institution three surgeon review identified patients undergoing direct-to-implant reconstruction with acellular dermal matrix and tissue expander-implant reconstruction without acellular dermal matrix from 2006-2011. Patients were prospectively followed through July 2014.
Results: 683 implant-based reconstructions were performed in 483 women followed an average of 5 (range 2.5-8) years. 462 were direct-to-implant while 221 were tissue expander-implant reconstructions. The average age was 49, mean BMI 25, 10% were smokers, and 16% had radiation.
There was no difference in total revision rates between direct-to-implant and tissue expander-implant reconstruction (21.0% vs. 19.9%, p=0.743). Subgroup analysis showed no difference in revision for malposition (3.5% vs. 5.4%, p=0.225), size change (6.7% vs. 5.4%, p=0.519), fat grafting (8.6% vs. 9.5%, p=0.717), or capsular contracture (4.6% vs. 3.2%, p=0.395).
Multivariate regression analysis showed complications were associated with higher rates of revisions for malposition or size in both groups (OR 2.8, CI 1.56-5.12, p=0.001). Smoking, preoperative radiation, skin necrosis, and one surgeon were associated with higher rates of fat grafting while increasing BMI had lower rates. Postoperative radiation (OR 2.9, CI 1.02-8.37, p<0.05) and hematoma (OR 7.0, CI 1.25-39.62, p=0.027) were predictive of revision for capsular contracture.
Conclusions: Direct-to-implant and tissue expander-implant reconstructions were associated with similar revision rates in this series. Surgical complications, radiation, and surgeon preference influenced the rate of revision in both groups.
Back to 2015 Annual Meeting Program