Background: Direct-to-implant breast reconstruction is a predictable, reliable, and cost-effective reconstruction. Most units performing direct-to-implant reconstructions recommend the use of an acellular dermal matrix or a mesh to reinforce the lower pole of the breast reconstruction.
Methods: Two hundred seventy-two consecutive patients with 488 immediate direct-to-implant breast reconstructions performed in a 34-month period are included in this group. Mean follow-up of this group is 35 months.
Results: Four hundred eight reconstructions were performed through a lazy-S mastectomy, and 80 were performed through a Wise pattern mastectomy. Two local recurrences occurred. Minor complications accounted for 5.5 percent (n = 27): seromas, 3.4 percent (n = 17); wound healing problems, 0.6 percent (n = 3); and grade 2 capsular contracture, 1.4 percent (n = 7). Major complications accounted for 4.3 percent (n = 21): infection, 0.8 percent (n = 4); prosthetic loss, 0.4 percent (n = 2); hematoma, 0.4 percent (n = 2); and wounds requiring débridement, 2 percent (n = 10). The additional cost of acellular dermal matrix is dependent on manufacturer and size, but increases the cost of the procedure by 35.5 to 47.7 percent.
Conclusions: This reconstruction method compares very favorably with published data from other units as far as early and late complications and cosmetic outcome are concerned. It has a complication rate similar to that of reconstructions using an acellular dermal matrix and is more cost effective.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Johannesburg, South Africa
From the University of the Witwatersrand and Milpark Breast Care Centre of Excellence.
Received for publication January 15, 2016; accepted September 16, 2016.
Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.
L. Charles. J. Serrurier, F.C.S.(Plast.Surg.)(C.M.S.A.), Netcare Breastcare Centre of Excellence, Suit E, Milpark Hospital, 9 Guild Road, Parktown West, Johannesburg 2193, South Africa, firstname.lastname@example.org