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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0000000000000171
Breast: Original Articles

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.

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Abstract

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.

©2014American Society of Plastic Surgeons

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