Direct-to-Implant vs Tissue Expander Placement in Immediate Breast Reconstruction: A Prospective Cohort Study

Area of Science:

• Plastic Surgery
• Breast Reconstruction
• Oncologic Surgery

Background:

• Direct-to-implant (DTI) breast reconstruction is increasingly utilized post-mastectomy.
• While concerns about flap ischemia exist, advancements have improved DTI safety.
• Comparing DTI with the traditional two-stage tissue expander (TE) approach is crucial.

Purpose of the Study:

• To compare clinical and patient-reported outcomes between DTI and TE breast reconstruction.
• To evaluate reconstructive failure rates and specific complications.
• To assess patient satisfaction and well-being post-reconstruction.

Main Methods:

• Prospective cohort study design.
• Comparison of reconstructive failure using logistic regression analyses.
• Assessment of complications (infection, seroma, flap necrosis, etc.) and BREAST-Q patient-reported outcomes.

Main Results:

• DTI patients were younger with fewer comorbidities and smaller breast sizes.
• Unadjusted analyses showed significantly lower rates of overall complications, reconstructive failure, and seroma in the DTI group.
• Adjusted analyses revealed no significant differences in reconstructive failure or complications.
• DTI reconstruction led to greater improvements in patient-reported satisfaction, psychosocial, and sexual well-being.

Conclusions:

• Prepectoral DTI breast reconstruction is a safe and effective option for select post-mastectomy patients.
• DTI reconstruction demonstrates favorable patient-reported outcomes.
• Careful patient selection is key for successful DTI outcomes.