Two-stage Implant-based Breast Reconstruction: Does the Final Volume Correlate with Complications?
StarKayla Lewis, BS, Joseph M. Escandón, MD, Jose G. Christiano, MD, Howard N. Langstein, MD, Oscar J. Manrique, MD.
University of Rochester Medical Center, Rochester, NY, USA.
PURPOSE: There is paucity in literature regarding the rate of complications in women who request high breast volumes after postmastectomy reconstruction. We investigated the impact of the final volume of implant-based breast reconstruction and clinical outcomes.
METHODS: A retrospective review of patients who underwent TE-to-Implant (Two-Stage) breast reconstruction between 2011-2015 was conducted. Demographics, comorbidities, and postoperative outcomes were recorded. Multivariate logistic regression analysis was performed to determine if the prosthesis volume was an independent predictor of complications after adjusting for potential confounding differences.
RESULTS: 158 subpectoral breast reconstructions in 98-patients were included. ADM was used in 91.8% of reconstructions. The average follow-up was 64.6-months (SD, 30.7). The overall rate of complication was 17.7% (n=28). Chemotherapy or radiotherapy significantly increased the odds of infection (p<.032), capsular contracture (p<.031), and overall complications requiring return to the operating room (p <.021). Only radiotherapy increased the odds of implant explanation (OR, 3.67, p=0.018). Using an implant with a greater volume than the weight of the mastectomy specimen did not increase the odds of infection (p=0.46), capsular contracture (p=0.119), explanation (p=0.21), or further surgical management (p=0.32). A final tissue expander (TE) volume greater than the mastectomy specimen weight increased approximately 2.72-fold the odds of capsular contracture (p=0.03). However, multivariate logistic regression model identified that only a longer follow-up (p=0.001) and radiotherapy (p<.001) were significant independent predictors for capsular contracture.
CONCLUSION: During two-stage implant-based breast reconstruction, higher TE and implant final volumes compared to the mastectomy specimen weight did not significantly increase the risk of complications.
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