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Direct to Implant versus 2-Stage Expander Implant Immediate Breast Reconstruction: Comparison of Incidence and Predictors of Complications

Year 2023, , 508 - 515, 01.10.2023

Altug Altinkaya , Sukru Yazar , Halil Kara , Akif Enes Arıkan , Cihan Uras

https://doi.org/10.31067/acusaglik.1291793

Abstract

Purpose: The most important discussion about the direct-to-implant (DTI) reconstruction is the risk of ischemic problems. Therefore, there is an ongoing debate about the effectiveness and reliability of DTI reconstruction. The current study aimed to compare the outcomes of patients undergoing DTI and expander implant (EI) reconstruction and to determine the factors that may affect the occurrence of complications.
Methods: Sixty patients who underwent immediate implant reconstruction over a two-year period were included in the study. Demographic characteristics, operative characteristics and postoperative complications of the patients were retrieved retrospectively from patient records.
Results: Reconstruction was performed on 34 and 27 breasts in the DTI and EI groups, respectively. The mean follow-up period of the patients was 13.8 months (range 6–28 months). Although the postoperative complication rates were high in the DTI group, no statistically significant difference was found between the two groups (p = 0.585). No statistically significant difference was found between the two groups in terms of implant failure (p = 0.579). Implant volumes of patients with complications in the DTI group were significantly higher than those without complications (p = 0.049).
Conclusion: While DTI was similar to EI reconstruction in terms of implant failure, overall complication rates were higher than those in EI reconstruction. The volume of the implant is a factor that affects the development of complications in DTI reconstruction. DTI reconstruction is a reliable method that can achieve similar results to EI reconstruction with fewer surgical procedures in suitably selected patients.

Keywords

mastectomy breast reconstruction direct to implant reconstruction expander implant reconstruction

References

  • Ringberg A, Tengroup I, Aspegren K, et al. Immediate breast reconstruction after mastectomy for cancer. Eur J Surg Oncol. 1999;25(5):470-6. DOI:10.1053/ejso.1999.0681.
  • Clough KB, Bourgeois D, Falcou MC, et al. Immediate breast reconstruction by prosthesis: A safe technique for extensive intraductal and microinvasive carcinomas. Ann Surg Oncol. 1996;3(2):212-8. DOI:10.1007/BF02305803.
  • Manrique OJ, Kapoor T, Banuelos J, et al. Single-stage direct-to-implant breast reconstruction: A comparison between subpectoral versus prepectoral implant placement. Ann Plast Surg. 2020;84(4):361-365. DOI:10.1097/SAP.0000000000002028
  • Colwell AS. Direct-to-implant breast reconstruction. Gland Surg. 2012;1(3):139-41. DOI:10.3978/j.issn.2227-684X.2012.10.04.
  • Negenborn VL, Dikmans REG, Bouman MB, et al. Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. Br J Surg. 2018;105(10):1305-1312. DOI:10.1002/bjs.10865.
  • Dikmans RE, Negenborn VL, Bouman MB, et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: An open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol. 2017;18(2):251-8.
  • Pallara T, Cagli B, Fortunato L, et al. Direct-to-implant and 2-stage breast reconstruction after nipple sparing mastectomy: Results of a retrospective comparison. Ann Plast Surg. 2019;83(4):392-5. DOI:10.1097/SAP.0000000000001893.
  • Azouz V, Lopez S, Wagner DS. Surgeon-controlled comparison of direct-to-implant and 2-stage tissue expander-implant immediate breast reconstruction outcomes. Ann Plast Surg. 2018;80(3):212-16. DOI:10.1097/SAP.0000000000001220. PMID:28984661.
  • Srinivasa DR, Garvey PB, Qi J, et al. Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg. 2017;140(5):869-877. DOI:10.1097/PRS.0000000000003748. Erratum in: Plast Reconstr Surg. 2018 Feb;141(2):532.
  • Gschwantler-Kaulich D, Leser C, Salama M, et al. Direct-to-implant breast reconstruction: Higher complication rate vs cosmetic benefits. Breast J. 2018;24(6):957-64. DOI:10.1111/tbj.13113.
  • Brunbjerg ME, Jensen TB, Overgaard J, et al. Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction-a cohort study. Gland Surg. 2021;10(1):207-18. DOI:10.21037/gs-20-581.
  • Davila AA, Mioton LM, Chow G, et al. Immediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction: A multi-institutional comparison of short-term complications. J Plast Surg Hand Surg. 2013;47(5):344-9. DOI:10.3109/2000656X.2013.767202.
  • Han HH, Kim HB, Kim EK, et al. Direct-to-implant as a frontline option for immediate breast reconstruction: A comparative study with 2-stage reconstruction. Ann Plast Surg. 2018;81(3):274-9. DOI:10.1097/SAP.0000000000001517.
  • Fischer JP, Wes AM, Tuggle CT 3rd, et al. Risk analysis of early implant loss after immediate breast reconstruction: A review of 14,585 patients. J Am Coll Surg. 2013;217(6):983-90. DOI:10.1016/j.jamcollsurg.2013.07.389.
  • Pusic AL, Cordeiro PG. Breast reconstruction with tissue expanders and implants: A practical guide to immediate and delayed reconstruction. Semin Plast Surg. 2004;18(2):71-7. DOI:10.1055/s-2004-829041.
  • Spear SL, Seruya M, Rao SS, et al. Two-stage prosthetic breast reconstruction using AlloDerm including outcomes of different timings of radiotherapy. Plast Reconstr Surg. 2012;130(1):1-9. DOI:10.1097/PRS.0b013e3182547a45.
  • Al-Ghazal SK, Sully L, Fallowfield L, et al. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol. 2000;26(1):17-9. DOI:10.1053/ejso.1999.0733.
  • Khoo A, Kroll SS, Reece GP, et al. A comparison of resource costs of immediate and delayed breast reconstruction. Plast Reconstr Surg. 1998;101(4):964-8; discussion 969-70. DOI:10.1097/00006534-199804040-00011.
  • Salzberg CA, Ashikari AY, Koch RM, et al. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg. 2011;127(2):514-24. DOI:10.1097/PRS.0b013e318200a961.
  • Basta MN, Gerety PA, Serletti JM, et al. A systematic review and head-to-head meta-analysis of outcomes following direct-to-implant versus conventional two-stage implant reconstruction. Plast Reconstr Surg. 2015;136(6):1135-44. DOI:10.1097/PRS.0000000000001749.
  • Serrurier LCJ, Rayne S, Venter M, et al. Direct-to-implant breast reconstruction without the use of an acellular dermal matrix is cost effective and oncologically safe. Plast Reconstr Surg. 2017;139(4):809-17. DOI:10.1097/PRS.0000000000003222.
  • Roostaeian J, Sanchez I, Vardanian A, et al. Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction. Plast Reconstr Surg. 2012;129(6):909e-918e. DOI:10.1097/PRS.0b013e31824ec411.
  • Fischer JP, Nelson JA, Kovach SJ, et al. Impact of obesity on outcomes in breast reconstruction: Analysis of 15,937 patients from the ACS-NSQIP datasets. J Am Coll Surg. 2013;217(4):656-64. DOI:10.1016/j.jamcollsurg.2013.03.031.
  • Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: Determining the incidence and significant predictors of complications. Plast Reconstr Surg. 2010;125(6):1606-14. DOI:10.1097/PRS.0b013e3181d4fb2a.
  • Blok YL, van Lierop E, Plat VD, et al. Implant loss and associated risk factors following implant-based breast reconstructions. Plast Reconstr Surg Glob Open. 2021;9(7):e3708. DOI:10.1097/GOX.0000000000003708.
  • Gdalevitch P, Ho A, Genoway K, et al. Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: Predictors of failure. Plast Reconstr Surg. 2014;133(6):738e-47e. DOI:10.1097/PRS.0000000000000171.
  • Du F, Liu R, Zhang H, et al. Post-mastectomy adjuvant radiotherapy for direct-to-implant and two-stage implant-based breast reconstruction: A meta-analysis. J Plast Reconstr Aesthet Surg. 2022;75(9):3030-40. DOI:10.1016/j.bjps.2022.06.063.
  • Yazar S, Bengur FB, Altinkaya A, et al. Nipple-sparing mastectomy and immediate implant-based reconstruction with or without skin reduction in patients with large ptotic breasts: A case-matched analysis. Aesthetic Plast Surg. 2021;45(3):956-967. DOI:10.1007/s00266-020-02000-w.

Mastektomi ile Eşzamanlı İmplant ile Tek Aşamalı ve İki Aşamalı Meme Rekonstrüksiyon Yöntem Sonuçlarının Kıyaslanması ve Komplikasyon Oluşumuna Etki Eden Faktörlerin Tespiti

Year 2023, , 508 - 515, 01.10.2023

Altug Altinkaya , Sukru Yazar , Halil Kara , Akif Enes Arıkan , Cihan Uras

https://doi.org/10.31067/acusaglik.1291793

Abstract

Purpose: Direct to implant (DTI) rekonstrüksiyon ile ilgili en önemli tartışma, konulan kalıcı implantın mastektomi flebine bası yaparak iskemik problemlere yol açacağı ve bu durumun implant failure neden olarak rekonstrüktif başarı oranını düşüreceğidir. Bu sebeple DTI rekonstrüksiyonun etkinliği ve güvenilirliği hakkında halen süregelen bir tartışma mevcuttur. Bu çalışmanın amacı DTI rekonstrüksiyon ile expander implant (EI) rekonstrüksiyon uygulanan hastalara ait sonuçları kıyaslamak ve komplikasyon oluşumuna etki edebilecek faktörleri tespit etmektir.
Methods: İki yıllık period içerisinde immediate implant reconstruction uygulanan 60 hasta çalışmaya dahil edildi. Hastalara ait demografik özellikler, operatif karakteristikler ve postoperatif komplikasyonlar retrospektif olarak hasta kayıtlarından tespit edildi. Komplikasyona etki eden faktörlerin tespiti için logistik regresyon analizi uygulandı.
Results: DTI grupta 34 memede EI grupta 27 memede rekonstrüksiyon uygulandı. Hastaların ortalama takip süresi 13.8 aydı (range 6 – 28). Postoperatif komplikasyon oranları DTI grupta daha yüksek olmasına karşın her iki grup arasında komplikasyon görülme sıklığı açısından anlamlı fark saptanmadı. (p=0,585) İmplant failure bakımından iki grup arasında anlamlı fark gözlenmedi. (p=0,579) DTI grupta komplikasyon olan hastaların implant volümleri komplikasyon olmayanlara göre istatistiksel olarak anlamlı yüksekti (p=0,049).
Conclusion: DTI rekonstrüksiyonda implant failure bakımından EI rekonstrüksiyona benzer oranlara sahip iken total komplikasyon oranları EI rekonstrüksiyona göre yüksektir. Konulacak implantın volümü, DTI rekonstrüksiyonda komplikasyon oluşumunda etkili bir faktör olarak görülmektedir. DTI rekonstrüksiyon uygun seçilmiş hastalarda daha az cerrahi prosedür ile EI rekonstrüksiyona benzer sonuçlar elde edilebilecek güvenilir bir yöntemdir.

Keywords

mastektomi meme rekonstrüksiyonu kalıcı implant ile rekonstrüksiyon expander implant ile rekonstrüksiyon

References

  • Ringberg A, Tengroup I, Aspegren K, et al. Immediate breast reconstruction after mastectomy for cancer. Eur J Surg Oncol. 1999;25(5):470-6. DOI:10.1053/ejso.1999.0681.
  • Clough KB, Bourgeois D, Falcou MC, et al. Immediate breast reconstruction by prosthesis: A safe technique for extensive intraductal and microinvasive carcinomas. Ann Surg Oncol. 1996;3(2):212-8. DOI:10.1007/BF02305803.
  • Manrique OJ, Kapoor T, Banuelos J, et al. Single-stage direct-to-implant breast reconstruction: A comparison between subpectoral versus prepectoral implant placement. Ann Plast Surg. 2020;84(4):361-365. DOI:10.1097/SAP.0000000000002028
  • Colwell AS. Direct-to-implant breast reconstruction. Gland Surg. 2012;1(3):139-41. DOI:10.3978/j.issn.2227-684X.2012.10.04.
  • Negenborn VL, Dikmans REG, Bouman MB, et al. Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. Br J Surg. 2018;105(10):1305-1312. DOI:10.1002/bjs.10865.
  • Dikmans RE, Negenborn VL, Bouman MB, et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: An open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol. 2017;18(2):251-8.
  • Pallara T, Cagli B, Fortunato L, et al. Direct-to-implant and 2-stage breast reconstruction after nipple sparing mastectomy: Results of a retrospective comparison. Ann Plast Surg. 2019;83(4):392-5. DOI:10.1097/SAP.0000000000001893.
  • Azouz V, Lopez S, Wagner DS. Surgeon-controlled comparison of direct-to-implant and 2-stage tissue expander-implant immediate breast reconstruction outcomes. Ann Plast Surg. 2018;80(3):212-16. DOI:10.1097/SAP.0000000000001220. PMID:28984661.
  • Srinivasa DR, Garvey PB, Qi J, et al. Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg. 2017;140(5):869-877. DOI:10.1097/PRS.0000000000003748. Erratum in: Plast Reconstr Surg. 2018 Feb;141(2):532.
  • Gschwantler-Kaulich D, Leser C, Salama M, et al. Direct-to-implant breast reconstruction: Higher complication rate vs cosmetic benefits. Breast J. 2018;24(6):957-64. DOI:10.1111/tbj.13113.
  • Brunbjerg ME, Jensen TB, Overgaard J, et al. Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction-a cohort study. Gland Surg. 2021;10(1):207-18. DOI:10.21037/gs-20-581.
  • Davila AA, Mioton LM, Chow G, et al. Immediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction: A multi-institutional comparison of short-term complications. J Plast Surg Hand Surg. 2013;47(5):344-9. DOI:10.3109/2000656X.2013.767202.
  • Han HH, Kim HB, Kim EK, et al. Direct-to-implant as a frontline option for immediate breast reconstruction: A comparative study with 2-stage reconstruction. Ann Plast Surg. 2018;81(3):274-9. DOI:10.1097/SAP.0000000000001517.
  • Fischer JP, Wes AM, Tuggle CT 3rd, et al. Risk analysis of early implant loss after immediate breast reconstruction: A review of 14,585 patients. J Am Coll Surg. 2013;217(6):983-90. DOI:10.1016/j.jamcollsurg.2013.07.389.
  • Pusic AL, Cordeiro PG. Breast reconstruction with tissue expanders and implants: A practical guide to immediate and delayed reconstruction. Semin Plast Surg. 2004;18(2):71-7. DOI:10.1055/s-2004-829041.
  • Spear SL, Seruya M, Rao SS, et al. Two-stage prosthetic breast reconstruction using AlloDerm including outcomes of different timings of radiotherapy. Plast Reconstr Surg. 2012;130(1):1-9. DOI:10.1097/PRS.0b013e3182547a45.
  • Al-Ghazal SK, Sully L, Fallowfield L, et al. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol. 2000;26(1):17-9. DOI:10.1053/ejso.1999.0733.
  • Khoo A, Kroll SS, Reece GP, et al. A comparison of resource costs of immediate and delayed breast reconstruction. Plast Reconstr Surg. 1998;101(4):964-8; discussion 969-70. DOI:10.1097/00006534-199804040-00011.
  • Salzberg CA, Ashikari AY, Koch RM, et al. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg. 2011;127(2):514-24. DOI:10.1097/PRS.0b013e318200a961.
  • Basta MN, Gerety PA, Serletti JM, et al. A systematic review and head-to-head meta-analysis of outcomes following direct-to-implant versus conventional two-stage implant reconstruction. Plast Reconstr Surg. 2015;136(6):1135-44. DOI:10.1097/PRS.0000000000001749.
  • Serrurier LCJ, Rayne S, Venter M, et al. Direct-to-implant breast reconstruction without the use of an acellular dermal matrix is cost effective and oncologically safe. Plast Reconstr Surg. 2017;139(4):809-17. DOI:10.1097/PRS.0000000000003222.
  • Roostaeian J, Sanchez I, Vardanian A, et al. Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction. Plast Reconstr Surg. 2012;129(6):909e-918e. DOI:10.1097/PRS.0b013e31824ec411.
  • Fischer JP, Nelson JA, Kovach SJ, et al. Impact of obesity on outcomes in breast reconstruction: Analysis of 15,937 patients from the ACS-NSQIP datasets. J Am Coll Surg. 2013;217(4):656-64. DOI:10.1016/j.jamcollsurg.2013.03.031.
  • Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: Determining the incidence and significant predictors of complications. Plast Reconstr Surg. 2010;125(6):1606-14. DOI:10.1097/PRS.0b013e3181d4fb2a.
  • Blok YL, van Lierop E, Plat VD, et al. Implant loss and associated risk factors following implant-based breast reconstructions. Plast Reconstr Surg Glob Open. 2021;9(7):e3708. DOI:10.1097/GOX.0000000000003708.
  • Gdalevitch P, Ho A, Genoway K, et al. Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: Predictors of failure. Plast Reconstr Surg. 2014;133(6):738e-47e. DOI:10.1097/PRS.0000000000000171.
  • Du F, Liu R, Zhang H, et al. Post-mastectomy adjuvant radiotherapy for direct-to-implant and two-stage implant-based breast reconstruction: A meta-analysis. J Plast Reconstr Aesthet Surg. 2022;75(9):3030-40. DOI:10.1016/j.bjps.2022.06.063.
  • Yazar S, Bengur FB, Altinkaya A, et al. Nipple-sparing mastectomy and immediate implant-based reconstruction with or without skin reduction in patients with large ptotic breasts: A case-matched analysis. Aesthetic Plast Surg. 2021;45(3):956-967. DOI:10.1007/s00266-020-02000-w.
There are 28 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Altug Altinkaya 0000-0003-1590-6844

Sukru Yazar 0000-0003-0352-956X

Halil Kara 0000-0002-1527-7155

Akif Enes Arıkan 0000-0003-1671-4510

Cihan Uras 0000-0002-6838-2311

Early Pub Date September 4, 2023
Publication Date October 1, 2023
Submission Date May 8, 2023
Published in Issue Year 2023

Cite

EndNote Altinkaya A, Yazar S, Kara H, Arıkan AE, Uras C (October 1, 2023) Direct to Implant versus 2-Stage Expander Implant Immediate Breast Reconstruction: Comparison of Incidence and Predictors of Complications. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 14 4 508–515.