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National Trends In Revision Procedures In Post-mastectomy Breast Reconstruction: Autologous Vs Implant-based Approaches
Shannon D. Francis, MSc1, Augustine W. Kang, PhD1, Bhagvat J. Maheta, BS2, Brian R. Sangalang, BS3, Sophia Salingaros, BA4, Robin T. Wu, MD5, Rahim Nazerali, MD, MHS5;
1Stanford University School of Medicine, Stanford, CA, USA, 2Northstate University College of Medicine, Elk Grove, CA, USA, 3University of California Riverside School of Medicine, Riverside, CA, USA, 4Weill Cornell Medical College, New York City, NY, USA, 5Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

PURPOSE: Breast reconstruction involves collaborative decision-making between patients and surgeons, but the need for multiple revisions can burden patients and the healthcare system. This study explores how the type of breast reconstruction (autologous, immediate implant-based reconstruction [IBR], or two-stage IBR) impacts post-reconstruction revisions.
METHODS: Using Marketscan Research Databases, we conducted a retrospective database study (2007-2021), identifying revision procedures through Current Procedural Terminology (CPT) codes. Statistical analysis with linear models, adjusted for patient characteristics and surgical factors, used a significance threshold of P < 0.05.
RESULTS: Among the 58,441, 19.8% of autologous reconstruction patients, 12.8% of immediate IBR patients, and 14.1% of two-stage IBR patients underwent future revisions. Notably, IBR required fewer revision operations (0.070.43) compared to autologous reconstruction (0.130.57, p < 0.001). Within IBR, there was no significant difference in the number of operations between immediate (0.0770.44) and two-stage reconstruction (0.0730.43, p = 0.3404). Immediate reconstruction demonstrated lower odds of requiring breast revision and fat grafting compared to autologous reconstruction (OR = p < 0.001 for both). Meanwhile, two-stage reconstruction had lower odds of requiring only fat grafting compared to autologous reconstruction (OR = p < 0.001).
CONCLUSION: Minimizing the need for aesthetic revisions in breast reconstruction is beneficial for both patients and healthcare systems. Autologous reconstruction necessitated a higher number of total revision procedures. Despite a potential increase in complication rates, our study indicates that IBR is the more efficient modality for achieving patients' final aesthetic goals.
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