Aesthetic and oncologic outcomes after one-stage immediate breast reconstruction using a permanent biodimensional expandable implant

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2016-02, Vol.69 (2), p.211-220
• Main Authors: Agusti, A, Ward, A, Montgomery, C, Mohammed, K, Gui, G.P.H
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biodimensional anatomical implants; Breast Neoplasms - diagnosis; Breast Neoplasms - mortality; Breast Neoplasms - surgery; Cancer recurrence; Esthetics; Expandable implants; Female; Humans; Immediate breast reconstruction; Incidence; Mammaplasty - methods; Mastectomy; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; One-stage implant reconstruction; Plastic Surgery; Prosthesis Design; Reoperation; Retrospective Studies; Skin-sparing mastectomy; Surgical Flaps; Survival Rate - trends; Time Factors; Tissue Expansion Devices; Treatment Outcome; United Kingdom - epidemiology; Young Adult
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2015.09.017

Summary Introduction Immediate breast reconstruction (IBR) with implants is the commonest method of reconstructive surgery after mastectomy. With careful patient selection, a stable implant pocket can be created at the primary operation to decrease the likelihood of further surgery to adjust the reconstructed side. One-stage IBR is cost effective but failed procedures requiring early revision may be costly as permanent expanders are expensive. Methods Data were prospectively collected on all women undergoing a planned one-stage immediate breast reconstruction between 1997 and 2010. All patients had a Style 150 implant (Allergan, Marlow, UK). Descriptive statistics, Kaplan–Meier plots and, where applicable, Cox Proportional Hazards Regression was used to compare outcomes between groups. Results 249 planned one-stage IBRs were performed in 193 women, median age 45 years (range 20–77) with median follow-up of 101 months (range 27–159 months). 18/193 (9%) patients required implant exchange at 12 months and 66% of patients maintained their original implants at the time of census. Implant assisted latissimus appears to be robust even when radiotherapy was delivered. Disease free survival and breast cancer mortality were as expected for the breast cancer stage treated. Conclusion With careful patient selection, one-stage implant IBR using a definitive anatomical expandable implant provides good long term reconstruction and safe oncologic outcome. Direct to implant decision algorithms may be influenced by future developments in acellular dermal matrix technology, but the ability to create a single-stage stable implant pocket with good surgical technique should not be forgotten.