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Breast Reconstruction Modality Outcome Study: A Comparison of Expander/Implants and Free Flaps in Select Patients

Fischer, John P. M.D.; Nelson, Jonas A. M.D.; Cleveland, Emily B.A.; Sieber, Brady M.D.; Rohrbach, Jeff I. M.S.N.; Serletti, Joseph M. M.D.; Kanchwala, Suhail M.D.

Plastic and Reconstructive Surgery: May 2013 - Volume 131 - Issue 5 - p 928–934
doi: 10.1097/PRS.0b013e3182865977
Breast: Original Articles

Background: Choosing a breast reconstructive modality after mastectomy is a critical step involving complex decisions. The authors provide outcomes data comparing two common reconstructive modalities to assist patients and surgeons in preoperative counseling and discussions.

Methods: A prospectively maintained database was queried identifying select patients undergoing expander/implant and abdominally based free flaps for breast reconstruction between 2005 and 2008. Variables evaluated included comorbidities, operations, time to reconstruction, complications, overall outcome, clinic visits, revisions, and costs.

Results: One hundred forty-two patients received free flaps and 60 received expander/implants. Expander/implant patients required more procedures (p < 0.001) but had shorter overall hospital lengths of stay (p < 0.001). The two cohorts experienced a similar rate of revision (p = 0.17). Free flap patients elected to undergo nipple-areola reconstruction more frequently (p = 0.01) and were able to sooner (p < 0.0001). Patients undergoing expander/implant reconstruction had a higher rate of failure (7.3 versus 1.3 percent, p = 0.008). Free flap patients achieved a stable reconstruction significantly faster (p = 0.0005), with fewer visits (p = 0.02). Cost analysis demonstrated total cost trended toward significantly lower in the free flap cohort (p = 0.15). Reconstructive modality was the only independent factor associated with time to stable reconstruction and reconstructive failure (p < 0.001 and p = 0.05, respectively).

Conclusions: The authors’ analysis revealed that free flap reconstructions required fewer procedures, had lower rates of complications and failures, had fewer clinic visits, and achieved a final, complete reconstruction faster than expander/implant reconstructions. Although autologous reconstruction is still not ideal for every patient, these findings can be used to enhance preoperative discussions when choosing a reconstructive modality.


Philadelphia, Pa.

From the Divisions of Plastic Surgery and Finance, Hospital of the University of Pennsylvania.

Received for publication September 12, 2012; accepted November 2, 2012.

Disclosure:The authors have no conflicts of interest to report.

Division of Plastic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pa. 19104,

©2013American Society of Plastic Surgeons