PMID- 38452172
OWN - NLM
STAT- Publisher
LR  - 20240307
IS  - 1527-330X (Electronic)
IS  - 1090-820X (Linking)
DP  - 2024 Mar 7
TI  - Direct-to-Implant vs Tissue Expander Placement in Immediate Breast 
      Reconstruction: A Prospective Cohort Study.
LID - sjae054 [pii]
LID - 10.1093/asj/sjae054 [doi]
AB  - BACKGROUND: Direct-to-implant (DTI) breast reconstruction after mastectomy has 
      gained increasing popularity. While concerns over ischemic complications related 
      to tension on the mastectomy flap persist, newer techniques and technologies have 
      enhanced safety of this technique. OBJECTIVES: To compare clinical and 
      patient-reported outcomes of DTI and two-stage tissue expander (TE) 
      reconstruction. METHODS: A prospective cohort design was utilized to compare the 
      incidence of reconstructive failure among patients undergoing DTI and TE 
      reconstruction via unadjusted bivariate and adjusted multivariable logistic 
      regression analyses. Secondary clinical outcomes of interest included specific 
      complications requiring intervention (infection, seroma, hematoma, mastectomy 
      flap necrosis, incisional dehiscence, device exposure) and time to final drain 
      removal. Patient-reported outcomes (PROs) via BREAST-Q were also compared. 
      RESULTS: A total of 134 patients (257 breasts) underwent DTI reconstruction and 
      222 patients (405 breasts) received TEs. DTI patients were significantly younger 
      with lower BMIs, less diabetes, hypertension, and smoking, and smaller breast 
      sizes, and underwent more nipple-sparing mastectomies with prepectoral 
      reconstructions. Rates of any complication (18% DTI vs 24% TE, p=0.047), 
      reconstructive failure (5.1% vs 12%, p=0.004), and seroma (3.9% vs 11%, p<0.001) 
      were significantly lower in the DTI cohort on unadjusted analyses; however, there 
      were no significant differences in adjusted regressions. Patient-reported 
      satisfaction with breasts, psychosocial well-being, and sexual well-being were 
      more substantively improved with DTI reconstruction. CONCLUSIONS: Prepectoral DTI 
      reconstruction is a viable option for post-mastectomy reconstruction in carefully 
      selected patients, with no significant increase in reconstructive failure or 
      other complications.
CI  - (c) The Author(s) 2024. Published by Oxford University Press on behalf of The 
      Aesthetic Society. All rights reserved. For permissions, please e-mail: 
      journals.permissions@oup.com.
FAU - Chiang, Sarah N
AU  - Chiang SN
AD  - Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington 
      University, St. Louis, MO, USA.
FAU - Keane, Alexandra M
AU  - Keane AM
AD  - Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington 
      University, St. Louis, MO, USA.
FAU - Ribaudo, Joseph G
AU  - Ribaudo JG
AD  - Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington 
      University, St. Louis, MO, USA.
FAU - Tao, Yu
AU  - Tao Y
AD  - Public Health Sciences Division, Department of Surgery, Washington University, 
      St. Louis, MO, USA.
FAU - Margenthaler, Julie A
AU  - Margenthaler JA
AD  - Division of Surgical Oncology, Department of Surgery, Washington University, St. 
      Louis, MO, USA.
FAU - Tenenbaum, Marissa M
AU  - Tenenbaum MM
AD  - Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington 
      University, St. Louis, MO, USA.
FAU - Myckatyn, Terence M
AU  - Myckatyn TM
AUID- ORCID: 0000-0002-9712-6181
AD  - Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington 
      University, St. Louis, MO, USA.
LA  - eng
PT  - Journal Article
DEP - 20240307
PL  - England
TA  - Aesthet Surg J
JT  - Aesthetic surgery journal
JID - 9707469
SB  - IM
EDAT- 2024/03/07 18:42
MHDA- 2024/03/07 18:42
CRDT- 2024/03/07 14:22
PHST- 2024/01/20 00:00 [received]
PHST- 2024/02/28 00:00 [revised]
PHST- 2024/03/05 00:00 [accepted]
PHST- 2024/03/07 18:42 [medline]
PHST- 2024/03/07 18:42 [pubmed]
PHST- 2024/03/07 14:22 [entrez]
AID - 7624033 [pii]
AID - 10.1093/asj/sjae054 [doi]
PST - aheadofprint
SO  - Aesthet Surg J. 2024 Mar 7:sjae054. doi: 10.1093/asj/sjae054.