Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix: Predictors of Failure

被引:48
作者
Gdalevitch, Perry [1 ]
Ho, Adelyn [1 ]
Genoway, Krista [1 ]
Alvrtsyan, Hasmik [1 ]
Bovill, Esta [1 ]
Lennox, Peter [1 ]
Van Laeken, Nancy [1 ]
Macadam, Sheina [1 ]
机构
[1] Univ British Columbia, Div Plast & Reconstruct Surg, Vancouver, BC V5Z 4J7, Canada
关键词
SURGEONS 12-YEAR EXPERIENCE; CAPSULE FORMATION; EXPANDER/IMPLANT RECONSTRUCTION; TISSUE MATRIX; ALLODERM; COMPLICATIONS; MASTECTOMY; PLACEMENT; RISK;
D O I
10.1097/PRS.0000000000000171
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Direct-to-implant single-stage immediate breast reconstruction using acellular dermal matrix is a cost-effective alternative to two-stage expander-implant reconstruction. The purpose of this study was to identify predictors of direct-to-implant single-stage immediate breast reconstruction failure, defined as need for early (<= 6 months) revision surgery. Methods: The authors conducted a retrospective cohort study of all patients with direct-to-implant single-stage immediate breast reconstruction in 2010 and 2011 at three University of British Columbia hospitals. Data were compared between successful and failed single-stage reconstructions. Predictors of failure were identified using multivariate logistic regression. Patient demographics and complications were compared to a random sample of control patients with two-stage alloplastic reconstruction without acellular dermal matrix. Results: Of 164 breasts that underwent direct-to-implant single-stage immediate breast reconstruction, 52 (31.7 percent) required early revision. Increasing breast cup size was the only significant predictor of early revision compared with bra size A (OR for bra size B, 4.86; C, 4.96; D, 6.01; p < 0.05). Prophylactic mastectomies showed a trend toward successful single stage (OR, 0.47; p = 0.061), whereas smoking history trended toward failure (OR, 1.79; p = 0.065). Mastectomy flap necrosis was significantly higher in direct-to-implant single-stage immediate reconstruction cases compared to two-stage controls. Conclusions: Direct-to-implant breast reconstruction can be reliably performed in a single stage in patients with small breast size. Increasing breast cup size confers a higher chance of early revision. A two-stage approach may be more cost-effective in larger breasted patients.
引用
收藏
页码:738E / 747E
页数:10
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