Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-year risks and patient-reported outcomes from a prospective, multicenter study Journal Article


Authors: Srinivasa, D. R.; Garvey, P. B.; Qi, J.; Hamill, J. B.; Kim, H. M.; Pusic, A. L.; Kronowitz, S. J.; Wilkins, E. G.; Butler, C. E.; Clemens, M. W.
Article Title: Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-year risks and patient-reported outcomes from a prospective, multicenter study
Abstract: 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., 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. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
Keywords: adult; middle aged; clinical trial; comparative study; follow up; follow-up studies; prospective study; prospective studies; mastectomy; logistic models; tissue expansion; postoperative complications; multicenter study; patient reported outcome measures; regression analysis; statistical model; breast augmentation; breast implantation; patient-reported outcome; procedures; humans; human; female
Journal Title: Plastic and Reconstructive Surgery
Volume: 140
Issue: 5
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2017-11-01
Start Page: 869
End Page: 877
Language: English
DOI: 10.1097/prs.0000000000003748
PUBMED: 29068918
PROVIDER: scopus
PMCID: PMC5902733
DOI/URL:
Notes: Article -- Export Date: 4 December 2017 -- Source: Scopus
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  1. Andrea Pusic
    300 Pusic