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Implant failure risk greater in direct-to-implant vs two-stage breast reconstruction

There was a greater risk for skin flap necrosis and implant failure in direct-to-implant breast reconstruction compared with two-stage tissue expander/implant reconstruction, according to study results.

Researchers conducted a literature search for articles published after 1999 involving a two-stage tissue expander/implant or using a direct-to-implant technique for prosthetic-based breast reconstruction. Search keywords included “breast reconstruction, breast implant, breast prosthesis, tissue expander” and “mastectomy.” A head-to-head meta-analysis was conducted, with implant loss, capsular contracture, reoperation and infection as the primary outcomes.

Thirteen studies involving 5,216 breast reconstructions (average patient age, 47.2 years; average follow-up, 40.8 months) met inclusion criteria.

There were similar rates of wound infection, seroma and capsular contracture risk between the two patient cohorts.  There was a higher risk for skip flap necrosis (OR = 1.43; 95% CI, 1.09-1.86) and reoperation (OR = 1.25; 95% CI, 1.02-1.53) in the direct-to-implant reconstructions.
“Ultimately, the risk for implant loss was nearly twofold higher with direct-to-implant reconstruction compared with tissue expander/implant reconstruction (OR = 1.87; 95% CI, 1.05-3.34),” the researchers wrote.

“These findings serve to aid in the risk-counseling process for patients and highlight the importance of continued investigation to assess outcomes more definitively,” the researchers concluded. – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.