The FAST Protocol: A Novel Approach for Staged Autologous Breast Reconstruction

Ideal timing for autologous reconstruction remains debated. The authors developed a novel flap after short tissue expansion (FAST) protocol that combines the benefits of both immediate and staged reconstruction by involving a very short tissue expander phase to delay the mastectomy pocket while still achieving expedient definitive reconstruction. The authors investigated outcomes of the FAST protocol in comparison with immediate, delayed, and more traditional staged autologous reconstruction, with a longer period between expander and flap reconstruction.

A retrospective investigation was performed of patients who underwent autologous reconstruction following the FAST protocol versus immediate, traditionally staged, or delayed reconstruction between 2017 and 2024. All study analyses were performed using Stata v18.

Of the study patients, 162 underwent immediate reconstruction, 26 received the FAST protocol, 35 received traditional staged reconstruction, and 18 were in the delayed cohort. Upon multivariable logistic regression, a traditional staged reconstruction significantly increased adjusted odds of infection compared with the FAST protocol (P = 0.02) and having an immediate reconstruction significantly increased adjusted odds of mastectomy skin necrosis compared with the FAST protocol (P = 0.01). Furthermore, immediate reconstruction was associated with a significantly greater mean operative time (P = 0.03). There were no differences in donor site complications, hospital length of stay, or unplanned readmissions or reoperations between cohorts.

The FAST protocol maximizes the quality of mastectomy skin while minimizing time to definitive reconstruction and infection risk by decreasing the time in which a prosthesis is in place. As such, it represents a promising model to optimize timing of autologous reconstruction.