From 0 to 100: Delayed Direct to Implant Breast Reconstruction, an Alternative to Tissue Expansion

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• Implant-based breast reconstruction can be challenging with poor mastectomy flap viability.
• Tissue expansion (TE) is a common staged approach, but may require additional procedures.
• Patients may opt to "go flat" before considering delayed reconstruction options.

Purpose of the Study:

• To evaluate the feasibility and outcomes of delayed direct-to-implant (dDTI) reconstruction.
• To compare dDTI with delayed tissue expander (TE) to implant reconstruction.
• To assess complication rates associated with dDTI versus TE.

Main Methods:

• Retrospective study comparing patients undergoing dDTI versus delayed TE reconstruction.
• Included patients who underwent implant placement without tissue expanders after mastectomy.
• Compared outcomes between 33 dDTI breasts and 31 TE breasts.

Main Results:

• dDTI demonstrated significantly fewer complications (3.0%) compared to TE (35.5%) (P < 0.01).
• Logistic regression indicated lower odds of complications with dDTI (OR, 0.06; P < 0.01).
• Average time between mastectomy and dDTI was approximately 279 days.

Conclusions:

• Delayed direct-to-implant reconstruction is a viable and safer alternative to TE.
• dDTI can potentially eliminate the need for additional surgeries and clinic visits.
• This technique offers a beneficial option when initial implant-based reconstruction is not feasible.