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Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix: Predictors of Failure

Gdalevitch, Perry M.D.; Ho, Adelyn M.D.; Genoway, Krista M.D.; Alvrtsyan, Hasmik M.S.; Bovill, Esta M.D., Ph.D.; Lennox, Peter M.D.; Van Laeken, Nancy M.D.; Macadam, Sheina M.D.

Plastic & Reconstructive Surgery: June 2014 - Volume 133 - Issue 6 - p 738e–747e
doi: 10.1097/PRS.0000000000000171
Breast: Original Articles
Best Paper

Background: Direct-to-implant single-stage immediate breast reconstruction using acellular dermal matrix is a cost-effective alternative to two-stage expander-implant reconstruction. The purpose of this study was to identify predictors of direct-to-implant single-stage immediate breast reconstruction failure, defined as need for early (≤6 months) revision surgery.

Methods: The authors conducted a retrospective cohort study of all patients with direct-to-implant single-stage immediate breast reconstruction in 2010 and 2011 at three University of British Columbia hospitals. Data were compared between successful and failed single-stage reconstructions. Predictors of failure were identified using multivariate logistic regression. Patient demographics and complications were compared to a random sample of control patients with two-stage alloplastic reconstruction without acellular dermal matrix.

Results: Of 164 breasts that underwent direct-to-implant single-stage immediate breast reconstruction, 52 (31.7 percent) required early revision. Increasing breast cup size was the only significant predictor of early revision compared with bra size A (OR for bra size B, 4.86; C, 4.96; D, 6.01; p < 0.05). Prophylactic mastectomies showed a trend toward successful single stage (OR, 0.47; p = 0.061), whereas smoking history trended toward failure (OR, 1.79; p = 0.065). Mastectomy flap necrosis was significantly higher in direct-to-implant single-stage immediate reconstruction cases compared to two-stage controls.

Conclusions: Direct-to-implant breast reconstruction can be reliably performed in a single stage in patients with small breast size. Increasing breast cup size confers a higher chance of early revision. A two-stage approach may be more cost-effective in larger breasted patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Vancouver, British Columbia, Canada

From the Division of Plastic and Reconstructive Surgery, University of British Columbia.

Received for publication March 5, 2013; accepted December 2, 2013.

Presented at the University of British Columbia Annual Chung Research Day, in Vancouver, British Columbia, Canada, September 14, 2012; the University of British Columbia Plastic Surgery Annual Research Day, in Vancouver, British Columbia, Canada, April 19, 2013; and the 67th Annual Meeting of the Canadian Society of Plastic Surgeons, in Calgary, Alberta, Canada, May 28 through June 1, 2013.

Disclosure: Dr. Lennox is a paid speaker for LifeCell Corp. and a paid consultant for Allergan Corp. The other authors have no financial interest to declare in relation to the content of this article.

Perry Gdalevitch, M.D., Plastic and Reconstructive Surgery, University of British Columbia, 777 West Broadway, Suite 1000, Vancouver, British Columbia V5Z 4J7, Canada, drperryg@gmail.com

©2014American Society of Plastic Surgeons