Quick blog.
There has been a growing movement of doing direct to implant breast reconstruction and skipping the traditional two stage reconstruction where a tissue expander is placed first at the time of mastectomy, followed by a second surgery where the expander is removed, and a final breast implant is placed.
This was a study out of Australia looking at over 5000 reconstructions, trying to answer the question- one stage vs two?
“Comparing Direct to to Implant and Two Stage Breast Reconstruction in the Australian Breast Device Registry.” May 2023 issue of Plastic and Reconstructive Surgery.
Study:
- This was 3000 two stagers and 2000 direct to implant patients
- Revision rates were 15.6% for direct to implant and 9.7% in the two stage reconstruction
- Reasons for revision were capsular contracture 25% vs 26% and implant malposition 26% vs 34%
- Use of acellular dermal matric was significantly associated with higher risk of revision
- They could not assess use of radiation on the revision rates
- Patient satisfaction levels were similar
- Patient experience was better with direct to implant
They conclude that direct to implant had a higher revision rate than two stage, but with comparable patient satisfaction and a better patient experience. In both types the biggest issues were with capsular contracture and implant malposition.
My thoughts?
Single stage reconstruction is appealing in so many ways. I have seen other studies which did not indicate that it had a higher rate of issues, though that study posited the reason why was that single stage reconstruction was only offered to patients with less aggressive/better tumors.
I don’t see how you can analyze capsular contracture and malposition without looking at who got radiated. Radiation is super tough on tissue and a huge cause of issues.
See my other blogs. This is actively being studied, which I applaud. Trying to make things easier for women going through breast cancer is a great goal.