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Safety Of Using Alternate Incision For Tissue Expander Exchange To Implant In Breast Reconstruction
Idanis Perez-Alvarez, MD, Annie Fritsch, BS, Nikki Rezania, BS, Rachel Williams, MD, Hannah Carr, MD, Santiago Ceron, MD, Jaime Pardo Palau, MD, MPH, Deana Shenaq, MD.
Rush University Medical Center, Chicago, IL, USA.
Purpose:Plastic surgeons are often trained that the use of an alternate incision (AI) to the initial mastectomy incision at the time of staged tissue expander exchange for implant-based reconstruction (IBR) increases risk of ischemic complications due to interruptions of blood flow to the flap. However, there is a lack of data qualifying this assumption. Our study seeks to demonstrate that the use of an alternate incision in staged reconstruction is safe.
Methods: A retrospective review of patients undergoing staged IBR from 2018-2024 at Rush University Medical Center by a single surgeon (DS) was completed. Information regarding patient comorbidities, surgical details, complications, and revisional procedures were collected.
Results: A total of 153 patients and 283 breasts were included in the review with 117 breasts utilizing an alternate incision and 166 utilizing the same incision (SI), further subdivided into nipple sparing mastectomy (NSM) with 81, and goldilocks wise pattern (GWP) with 85. Total complications occurred in 4 (3.4%) AI breasts, 2 (2.5%) NSM and 2 (2.4%) GWP (p=1.0). These included infection (2 AI), implant malposition (2 AI), hematoma (2 NSM) and wound dehiscence (2 GWP). No ischemic complications were noted in any group (Table 1).
Conclusion:There is no increased risk of complications, in particular ischemic complications, when AI is used for staged reconstruction. Furthermore, breast projection was preserved and aesthetic outcomes improved with this technique.
Table 1. Surgical Complications and Revisional Procedures. | | | | | |
| Variable | All (283) | Alternate Incision(117) | Same Incision (166) | P value |
| | | Nipple Sparing (81) | Goldilocks Wise (85) | |
| Complications | 8 (2.8%) | 4 (3.4%) | 2 (2.5%) | 2 (2.4%) | 1.0 |
| Acute Complications | 6 (2.1%) | 2 (1.7%) | 2 (2.5%) | 2 (2.4%) | 1.0 |
| Chronic Complications | 2 (0.07%) | 2 (1.7%) | 0 (0%) | 0 (0%) | 0.340 |
| Ischemic Complications | 0 (0%) | - | - | - | - |
| Revisions Fat grafting Nipple Recon Skin excision Capsulectomy/Capsulorrhaphy Implant Exchange Autologous | 6917112
161 | 281416
81 | 30005
50 | 111301
30 | 0.001--0.230
.507- |
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