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Comparison of Immediate Implant Placement versus the Staged Tissue Expander Technique in Breast Reconstruction

Roostaeian, Jason M.D.; Sanchez, Ivan B.S.; Vardanian, Andrew M.D.; Herrera, Fernando M.D.; Galanis, Charles M.D.; Da Lio, Andrew M.D.; Festekjian, Jaco M.D.; Crisera, Christopher A. M.D.

Plastic and Reconstructive Surgery: June 2012 - Volume 129 - Issue 6 - p 909e–918e
doi: 10.1097/PRS.0b013e31824ec411
Breast: Original Articles

Background: Tissue expansion is currently the most common method used in prosthetic breast reconstruction. Skin-sparing mastectomy techniques have facilitated immediate placement of a permanent implant. Proposed benefits to immediate implants include less time and fewer operations to complete reconstruction. Whether it leads to poorer outcomes remains unknown. The authors compared immediate implant-based and staged tissue expander breast reconstruction.

Methods: Thirty-five consecutive immediate implant-based breast reconstruction patients (62 breasts) and a matched group of 50 tissue expander immediate reconstruction patients (89 breasts) were identified. Normative data, complication rates, revision rates, number of office visits, total reconstructive time, and aesthetic outcomes were compared.

Results: Demographic variables and surgical risk factors were similar in both groups. At a mean follow-up of 14 months, the overall complication rates were similar (p = 0.97), and the need for revision surgery was also similar (p = 0.94). Mean final implant volume did not differ between the two groups (397 ± 93 cc for implants and 386 ± 128 cc for expansion; p = 0.57). Mean number of office visits/time to nipple reconstruction was significantly different at 5.0 ± 4 versus 9.2 ± 3 visits (p < 0.001) and 22 ± 19 versus 43 ± 24 weeks (p < 0.001) in the implant versus tissue expander group, respectively. Aesthetic evaluation revealed no significant differences.

Conclusions: Immediate implant-based breast reconstruction has similar complication rates, need for revision, and aesthetic outcomes but fewer office visits and less reconstructive time when compared with tissue expander immediate breast reconstruction. In the appropriately selected patient, it is a safe option that provides similar outcomes in less time compared with staged expander-based reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Los Angeles, Calif.

From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.

Received for publication October 10, 2011; accepted December 27, 2011.

Disclosure:Dr. Crisera and Dr. Festekjian serve on the speakers' bureau for LifeCell Corp. The other authors have no financial interest to declare. There are no commercial associations that might pose or create a conflict of interest with information presented in this article.

Christopher A. Crisera, M.D.; Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, 200 Medical Plaza, Suite 465, Los Angeles, Calif. 90095, ccrisera@mednet.ucla.edu

©2012American Society of Plastic Surgeons