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Shaped versus Round Implants in Breast Reconstruction: A Multi-Institutional Comparison of Surgical and Patient-Reported Outcomes

Khavanin, Nima M.D.; Clemens, Mark W. M.D.; Pusic, Andrea L. M.D., M.H.S.; Fine, Neil A. M.D.; Hamill, Jennifer B. M.P.H.; Kim, H. Myra Sc.D.; Qi, Ji M.S.; Wilkins, Edwin G. M.D., M.S.; Kim, John Y. S. M.D., M.A.

Plastic & Reconstructive Surgery: May 2017 - Volume 139 - Issue 5 - p 1063–1070
doi: 10.1097/PRS.0000000000003238
Breast: Outcomes Articles

Background: Since the 2012 approval of shaped implants, their use in breast reconstruction has increased in the United States. However, large-scale comparisons of complications and patient-reported outcomes are lacking. The authors endeavored to compare surgical and patient-reported outcomes across implant types.

Methods: The Mastectomy Reconstruction Outcomes Consortium database was queried for expander/implant reconstructions with at least 1-year postexchange follow-up (mean, 18.5 months). Outcomes of interest included postoperative complications, 1-year revisions, and patient-reported outcomes. Bivariate and mixed-effects regression analyses evaluated the effect of implant type on patient outcomes.

Results: Overall, 822 patients (73.5 percent) received round and 297 patients (26.5 percent) received shaped implants. Patients undergoing unilateral reconstructions with round implants underwent more contralateral symmetry procedures, including augmentations (round, 18.7 percent; shaped, 6.8 percent; p = 0.003) and reductions (round, 32.2 percent; shaped, 20.5 percent; p = 0.019). Shaped implants were associated with higher rates of infection (shaped, 6.1 percent; round, 2.3 percent; p = 0.002), that remained significant after multivariable adjustment. Other complication rates did not differ significantly between cohorts. Round and shaped implants experienced similar 2-year patient-reported outcome scores.

Conclusions: This prospective, multicenter study is the largest evaluating outcomes of shaped versus round implants in breast reconstruction. Although recipients of round implants demonstrated lower infection rates compared with shaped implants, these patients were more likely to undergo contralateral symmetry procedures. Both implant types yielded comparable patient-reported outcome scores. With appropriate patient selection, both shaped and round implants can provide acceptable outcomes in breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Baltimore, Md.; Houston, Texas; New York, N.Y.; Chicago, Ill.; and Ann Arbor, Mich.

From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine; and the Section of Plastic Surgery and the Department of Biostatistics, University of Michigan.

Received for publication August 24, 2016; accepted October 24, 2016.

Disclosure: Dr. Kim and Dr. Clemens are past advisory board members of Allergan. All other authors have no relevant disclosures.

John Y. S. Kim, M.D., M.A., Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, Ill. 60611, jokim@nm.org

©2017American Society of Plastic Surgeons