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Direct-to-Implant Breast Reconstruction in Women Older than 65 Years: A Retrospective Analysis of Complication Rate and Overall Outcomes

Knackstedt, Rebecca, M.D., Ph.D.; Gatherwright, James, M.D.; Moreira, Andrea, M.D.

Plastic and Reconstructive Surgery: February 2018 - Volume 141 - Issue 2 - p 251–256
doi: 10.1097/PRS.0000000000004015
Breast: Original Articles
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Background: Half of all cancers occur in women older than 65 years, yet only 4 to 14 percent of these women undergo reconstruction. Most studies on reconstruction in the elderly have focused on tissue expander/implant or autologous reconstruction. A direct-to-implant approach theoretically reduces the number of operations and postoperative visits, but has yet to be investigated in the elderly.

Methods: Institutional review board approval was granted for a retrospective chart review for patients who underwent direct-to-implant reconstruction from 2012 to 2015 with any staff in the authors’ department. A control cohort of patients who underwent tissue expander/implant-based reconstruction from the same period was analyzed.

Results: Direct-to-implant reconstruction was performed in 24 breasts in 19 patients with at least 30-day follow-up and in 17 breasts in 14 patients with at least 1-year follow-up. A control group analysis of tissue expander/implant patients was performed for 109 breasts in 88 patients. The tissue expander/implant group was significantly younger (p = 0.001), with a lower body mass index (p = 0.004). There was no difference in the rate of seroma, hematoma, infection, necrosis, or failed reconstruction. Direct-to-implant patients had significantly reduced numbers of drain days (p < 0.001), length of stay (p = 0.05 and p = 0.039), readmissions (p = 0.03 and 0.03), extra hospital days (p = 0.05 and p = 0.045), and postoperative visits (p < 0.001).

Conclusions: Direct-to-implant breast reconstruction in the elderly yields similar complication and failure rates compared to tissue expander/implant reconstruction. However, direct-to-implant reconstruction patients had a reduced number of drain days and fewer readmissions, hospital stays, and postoperative visits. Direct-to-implant reconstruction is a powerful tool to use in elderly women with appropriate breast shape and ptosis.


MetroHealth, Cleveland, Ohio

From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation.

Received for publication June 22, 2017; accepted September 1, 2017.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

Andrea Moreira, M.D., Cleveland Clinic, Crile Building, 2049 East 100th Street, Mail Code A60, Cleveland, Ohio 44195,

©2018American Society of Plastic Surgeons