PMID- 37699106
OWN - NLM
STAT- Publisher
LR  - 20230912
IS  - 1529-4242 (Electronic)
IS  - 0032-1052 (Linking)
DP  - 2023 Sep 12
TI  - Prepectoral Direct-to-Implant versus Staged Tissue Expander Breast 
      Reconstruction: A Comparison of Complications.
LID - 10.1097/PRS.0000000000011053 [doi]
AB  - BACKGROUND: Direct-to-implant (DTI) reconstruction has multiple advantages over a 
      staged tissue expander (TE) approach. However, its use may be limited by concerns 
      of increased complications. This study is the largest series to date comparing 
      postoperative outcomes for DTI versus TE reconstruction in the prepectoral plane. 
      METHODS: The authors retrospectively reviewed 348 patients that received 536 
      total immediate, prepectoral implant-based breast reconstructions between January 
      2018 and December 2021. The authors compared the presence of risk factors and the 
      rate of six separate complications between patients that received DTI versus TE 
      reconstruction up to one year after surgery. RESULTS: Of 348 patients, 147 (42%) 
      and 201 (58%) underwent TE and DTI reconstruction (p=0.1813), respectively. 
      Overall infection rate was 16.4% (n=57). DTI patients had a significantly greater 
      incidence of wounds (p<0.0001), including minor (p<0.0011) and major wounds 
      (p<0.0053). Significantly greater mastectomy resection weights were found for DTI 
      patients that experienced any complication (p<0.0076), postoperative wounds 
      (p<0.0001), and major wounds specifically (p<0.0035). Compared to medium 
      thickness, extra-thick acellular dermal matrix (ADM) was associated with 
      significantly increased rates of infection (p<0.0408) and wounds (p<0.0001). 
      CONCLUSIONS: Prepectoral DTI reconstruction in patients with adequate flap 
      perfusion may have comparable complication rates to staged TE reconstruction 
      apart from a higher incidence of postoperative wounds. Greater mastectomy 
      resection weights and thickness of ADM may specifically contribute to infectious 
      and wound-healing complications. Prepectoral DTI reconstruction is encouraged in 
      the patients with adequate flap perfusion and moderate to low mastectomy 
      resection weights that desire comparable or smaller implant volumes.
CI  - Copyright (c) 2023 by the American Society of Plastic Surgeons.
FAU - Finkelstein, Emily R
AU  - Finkelstein ER
AD  - Department of Surgery, Division of Plastic and Reconstructive Surgery, University 
      of Miami Miller School of Medicine, Miami, Florida.
FAU - Vidal Laureano, Natalia
AU  - Vidal Laureano N
FAU - Azizi, Armina
AU  - Azizi A
FAU - Smartz, Taylor
AU  - Smartz T
FAU - Zheng, Caiwei
AU  - Zheng C
FAU - Lessard, Anne-Sophie
AU  - Lessard AS
FAU - Panthaki, Zubin
AU  - Panthaki Z
FAU - Oeltjen, John
AU  - Oeltjen J
FAU - Kassira, Wrood
AU  - Kassira W
LA  - eng
PT  - Journal Article
DEP - 20230912
PL  - United States
TA  - Plast Reconstr Surg
JT  - Plastic and reconstructive surgery
JID - 1306050
SB  - IM
COIS- Financial Disclosure Statement: All authors have no disclosures and no conflicts 
      of interest.
EDAT- 2023/09/12 18:42
MHDA- 2023/09/12 18:42
CRDT- 2023/09/12 14:22
PHST- 2023/09/12 18:42 [medline]
PHST- 2023/09/12 18:42 [pubmed]
PHST- 2023/09/12 14:22 [entrez]
AID - 00006534-990000000-02114 [pii]
AID - 10.1097/PRS.0000000000011053 [doi]
PST - aheadofprint
SO  - Plast Reconstr Surg. 2023 Sep 12. doi: 10.1097/PRS.0000000000011053.