Revision Rate of Direct-to-Implant Breast Reconstruction: Is it Truly a Single-Stage Reconstruction? A Single-Surgeon Experience

Introduction There has been increased interest in direct-to-implant (DTI) reconstruction in recent years. The goal of this study was to focus on the re-operation rate of DTI in comparison with two-stage tissue expander (TE) reconstruction. Patients and Methods In total, 165 consecutive patients (222 breasts) underwent skin sparing mastectomy and immediate implant-based reconstruction between January 2010 and December 2019. Patients were divided to TE procedure and DTI (42,180 breasts, respectively). Data collected included demographics, operative details and oncological medical treatment, complications classified according to Clavien-Dindo, capsular contracture Baker 3-4 and re-operation due to complication or due to patient's wish to improve aesthetic appearance. Results There were significantly more prophylactic mastectomies and BRCA gene mutation in the DTI breast reconstruction group, and more smokers and diabetic patients in the TE group. No significant difference was found in the complication rates between the groups (DTI-26.1%, TE-40.5%). However, major complication and re-operation rate due to complications were significantly different ( DTI-16.7% and 10.6%, TE-26.2% and 31%, respectively, p= 0.035, p = 0.008). No significant differences were found in Clavien-Dindo stages between the groups except for Grade 3b. Re-operation due to desire for aesthetic improvement was significantly higher in the TE group (DTI-38%. TE-69%, p=0.0003). Conclusion DTI immediate breast reconstruction can provide a good alternative to the traditional two-stage TE/implant operation. Both patients and surgeons can be reassured that the majority of the cases are one-stage reconstruction. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.