Immediate 1-stage vs. tissue expander postmastectomy implant breast reconstructions: A retrospective real-world comparison over 18 months

Background: Postmastectomy implant breast reconstruction is typically accomplished in a two-stage process involving a tissue expander that is later exchanged for a permanent implant. Adoption of an immediate one stage reconstruction (1-stage) approach, where feasible, has been slowed by surgeon perception that this method is less likely to achieve acceptable results. Methods: To compare outcomes of these approaches in actual practice, we obtained commercial insurance claims on 1,316 patients throughout the United States who had immediate 1-stage or tissue expander (TE) postmastectomy implant breast reconstructions in 2008, without flaps, and compared results of these two reconstructive approaches over 18 months in terms of patient complication rates and return visits for additional procedures and/or treatment of complications. Results: Immediate 1-stage reconstructions were identified in 95 patients (7.2 percent), mean age 49.3 years, while 1,221 (92.8 percent), mean age 49.1 years, had TE reconstructions. Data shows a modest, non-significant trend toward fewer return visits after 1-stage reconstructions vs. TE reconstructions (191 vs. 242/100 patients, respectively); RR 0.95, NS. Complications of the implant, graft or mesh were the most common complication, experienced by 28.4 percent of 1-stage and 27.4 percent of TE reconstruction patients (RR 1.03, NS). Complications involving skin or connective tissue were also common, occurring in 20.0 percent of 1-stage and 26.4 percent of TE reconstruction patients (RR 0.76, NS). The average time to expander exchange was 189 days in patients without radiation and 288 days among irradiated patients. Conclusions: The results show that surgeons in the United States achieved substantially similar results in immediate postmastectomy implant breast reconstructions with 1-stage and TE approaches in terms of patient complications and returns for reconstruction-related services over 18 months. As evolving mastectomy techniques make 1-stage implant reconstructions more attractive, we hope these findings will motivate researchers to compare the approaches in more strictly controlled clinical studies.