Summary
Background
Postmastectomy implant breast reconstruction is typically accomplished in a two-stage
process involving a tissue expander that is later exchanged for a permanent implant.
Adoption of an immediate one stage reconstruction (1-stage) approach, where feasible,
has been slowed by surgeon perception that this method is less likely to achieve acceptable
results.
Methods
To compare outcomes of these approaches in actual practice, we obtained commercial
insurance claims on 1,316 patients throughout the United States who had immediate
1-stage or tissue expander (TE) postmastectomy implant breast reconstructions in 2008,
without flaps, and compared results of these two reconstructive approaches over 18
months in terms of patient complication rates and return visits for additional procedures
and/or treatment of complications.
Results
Immediate 1-stage reconstructions were identified in 95 patients (7.2 percent), mean
age 49.3 years, while 1,221 (92.8 percent), mean age 49.1 years, had TE reconstructions.
Data shows a modest, non-significant trend toward fewer return visits after 1-stage
reconstructions vs. TE reconstructions (191 vs. 242/100 patients, respectively); RR
0.95, NS. Complications of the implant, graft or mesh were the most common complication,
experienced by 28.4 percent of 1-stage and 27.4 percent of TE reconstruction patients
(RR 1.03, NS). Complications involving skin or connective tissue were also common,
occurring in 20.0 percent of 1-stage and 26.4 percent of TE reconstruction patients
(RR 0.76, NS). The average time to expander exchange was 189 days in patients without
radiation and 288 days among irradiated patients.
Conclusions
The results show that surgeons in the United States achieved substantially similar
results in immediate postmastectomy implant breast reconstructions with 1-stage and
TE approaches in terms of patient complications and returns for reconstruction-related
services over 18 months. As evolving mastectomy techniques make 1-stage implant reconstructions
more attractive, we hope these findings will motivate researchers to compare the approaches
in more strictly controlled clinical studies.
Keywords
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Article info
Publication history
Published online: February 20, 2012
Accepted:
December 21,
2011
Received:
October 15,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
