Adjuvant Chemotherapy in Two-Stage Tissue Expander/Implant Breast Reconstruction: Does it Affect Final Outcomes?

Abstract Background Direct-to-implant (DTI) breast reconstruction is increasingly performed as the preferred method of immediate breast reconstruction following mastectomy. The proposed advantages of DTI over two-stage tissue expander (TE)/implant reconstruction relate to fewer surgical procedures. This systematic review and meta-analysis aims to evaluate the safety and efficacy of DTI versus conventional TE/implant breast reconstruction. Method A systematic review was performed (PubMed, Embase, Scopus) to identify relevant studies that compared outcomes between DTI and TE/Implant reconstructions. Publications up to October 2020 were included. The primary outcome was overall complication rate. Secondary outcomes included infection rate and implant loss. Results Nineteen studies, including 32,971 implant-based breast reconstructions, were analysed. Median age was 48 years. Mean BMI was 25.9. There was no statistically significant difference between the two groups. Duration of follow up ranged from 1-60 months. Overall complications were significantly more likely to occur in the DTI group (OR 1.81 [1.17-2.79]). Overall complications refers to all reported complications including seroma, haematoma, would dehiscence, infection, skin necrosis and capsular contracture. Implant loss was also significantly higher in the DTI cohort (OR 1.31 [1.12-1.78]). There was no significant difference in infection rates between the two groups. Subgroup analyses, focusing on high-powered multicentre studies showed that the risks of overall complications were significantly higher in the DTI group (OR 1.51 [1.06-2.14]). Conclusions This meta-analysis demonstrates significantly greater risk of complications and implant loss in the DTI breast reconstruction group. These findings serve to aid both patients and clinicians in the decision-making process regarding implant reconstruction following mastectomy

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Immediate two-stage tissue expander vs single-stage direct-to-implant breast reconstruction: two case reports of identical twins with BRCA 2 mutation

Slovenian Medical Journal ◽

10.6016/zdravvestn.1283 ◽

2015 ◽

Vol 84 (11) ◽

Author(s):

Aleš Porčnik ◽

Uroš Ahčan

Keyword(s):

Breast Reconstruction ◽

Case Reports ◽

Tissue Expander ◽

Single Stage ◽

Two Stage ◽

Aesthetic Result ◽

Advantages And Disadvantages ◽

Brca 2 ◽

Immediate Implant ◽

Implant Breast Reconstruction

In order to achieve the best aesthetic result after immediate implant-based breast reconstruction, all the advantages and disadvantages of two-stage tissue expander and single-stage direct-to-implant breast reconstruction should be considered. Decision about the type of implant-based reconstruction is based on the consultations outcomes after multidisciplinary team meeting of breast and reconstructive specialist, but patients own wishes should be prioritised.

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Use of Fenestrations in Acellular Dermal Allograft in Two-Stage Tissue Expander/Implant Breast Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000000598 ◽

2014 ◽

Vol 134 (5) ◽

pp. 901-904 ◽

Cited By ~ 19

Author(s):

Jenna B. Martin ◽

Ryan Moore ◽

Keyianoosh Z. Paydar ◽

Garrett A. Wirth

Keyword(s):

Breast Reconstruction ◽

Tissue Expander ◽

Two Stage ◽

Acellular Dermal ◽

Implant Breast Reconstruction

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Bilateral Two-Stage Tissue Expander/Implant Breast Reconstruction

Breast Reconstruction ◽

10.1007/978-3-319-18726-6_37 ◽

2016 ◽

pp. 423-433

Author(s):

Elizabeth Shay ◽

Emily Robinson ◽

Katherine A. Rodby ◽

Jessina Thomas ◽

Anuja K. Antony

Keyword(s):

Breast Reconstruction ◽

Tissue Expander ◽

Two Stage ◽

Implant Breast Reconstruction

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Long-term outcomes of two-stage, immediate and delayed breast reconstruction with polyurethane-covered versus textured implants: protocol of a prospective, multicentre randomised controlled trial (TIPI trial)

BMJ Open ◽

10.1136/bmjopen-2020-044219 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044219

Author(s):

J X Harmeling ◽

Kevin Peter Cinca ◽

Eleni-Rosalina Andrinopoulou ◽

Eveline M L Corten ◽

M A Mureau

Keyword(s):

Randomised Controlled Trial ◽

Breast Reconstruction ◽

Controlled Trial ◽

Capsular Contracture ◽

Tissue Expander ◽

Complication Rates ◽

Two Stage ◽

Randomised Controlled

IntroductionTwo-stage implant-based breast reconstruction is the most commonly performed postmastectomy reconstructive technique. During the first stage, a tissue expander creates a sufficiently large pocket for the definite breast implant placed in the second stage. Capsular contracture is a common long-term complication associated with implant-based breast reconstruction, causing functional complaints and often requiring reoperation. The exact aetiology is still unknown, but a relationship between the outer surface of the implant and the probability of developing capsular contracture has been suggested. The purpose of this study is to determine whether polyurethane-covered implants result in a different capsular contracture rate than textured implants.Methods and analysisThe Textured Implants versus Polyurethane-covered Implants (TIPI) trial is a multicentre randomised controlled trial with a 1:1 allocation rate and a follow-up of 10 years. A total of 321 breasts of female adults undergoing a two-stage breast reconstruction will be enrolled. The primary outcome is capsular contracture at 10-year follow-up which is graded with the modified Baker classification. It is analysed with survival analysis using a frailty model for clustered interval-censored data, with both an intention-to-treat and per-protocol approach. Secondary outcomes are other complication rates, surgical revision rate, patient satisfaction and quality of life and user-friendliness. Outcomes are measured 2 weeks, 6 months, 1, 2, 3, 5 and 10 years postoperatively. Interim analysis is performed when 1-year, 3-year and 5-year follow-up is completed.Ethics and disseminationThe trial has been reviewed and approved by the Medical Research Ethics Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2018-126) and locally by each participating centre. Written informed consent will be obtained from each study participant. The results will be disseminated by publication in peer-reviewed journals.Trial registrationNTR7265.

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Letter to the Editor: Sub-muscular Reconstruction After NAC Sparing Mastectomy—Direct to Implant Breast Reconstruction with Human ADM Versus Tissue Expander

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02058-6 ◽

2021 ◽

Author(s):

Bishara S. Atiyeh ◽

Fadl Chahine

Keyword(s):

Breast Reconstruction ◽

Tissue Expander ◽

Letter To The Editor ◽

Implant Breast Reconstruction

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Update in Direct-to-Implant Breast Reconstruction

Seminars in Plastic Surgery ◽

10.1055/s-0039-1697028 ◽

2019 ◽

Vol 33 (04) ◽

pp. 264-269 ◽

Cited By ~ 1

Author(s):

Aurelia Trisliana Perdanasari ◽

Amjed Abu-Ghname ◽

Sarth Raj ◽

Sebastian J. Winocour ◽

Rene D. Largo

Keyword(s):

Postoperative Complications ◽

Breast Reconstruction ◽

Two Stage ◽

Surgical Technology ◽

One Stage ◽

One Stage Reconstruction ◽

Reconstruction Option ◽

Implant Breast Reconstruction

AbstractImplant-based reconstruction (IBR) remains the most commonly utilized breast reconstruction option for post-mastectomy patients. IBR can be approached as either a one-stage reconstruction or a two-stage reconstruction. Facilitated by improvements in surgical technology and advanced techniques, one-stage reconstruction, also known as direct-to-implant (DTI) reconstruction, involves the insertion of an implant at the time of mastectomy. The decision to pursue either a DTI or a two-stage reconstruction is based on several factors, including the patient's overall health, expected risk of postoperative complications, and associated costs to both the patient and hospital.

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