Long-term Outcomes of Direct-to-Implant Breast Reconstruction Versus Two-Stage Tissue Expander Implant Reconstruction: A Retrospective Comparative Study
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Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
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Implant-based breast reconstruction (IBBR) is the most performed reconstructive technique following mastectomy for breast cancer. It can be achieved either as a direct-to-implant (DTI) procedure or as a traditional two-stage approach involving initial tissue expander placement followed by implant exchange. Comparative data on early and long-term outcomes between these approaches remain heterogeneous.
This retrospective cohort study included 139 patients who underwent DTI or two- stage IBBR at Turku University Hospital between January 2009 and December 2024. Of the 139 patients analyzed, 94 underwent direct-to-implant reconstruction and 45 underwent two-stage reconstruction. Patient demographics, comorbidities, oncologic treatments, and operative details were collected from medical records. Primary outcomes included early and late postoperative complications, unplanned reoperations, and implant revision or removal.
The overall complication rate did not differ significantly between DTI and two- stage reconstruction. Early implant removal within 30 days occurred more frequently following DTI reconstruction. Late reoperation rates were similar between groups; however, patients in the DTI cohort underwent significantly fewer reconstructive procedures overall. Rates of capsular contracture and late implant exchange or removal were comparable.
Direct-to-implant and two-stage implant-based breast reconstruction demonstrate comparable overall success and long-term outcomes. The key distinction lies in the risk profile: DTI reconstruction is associated with a higher risk of early implant loss, whereas the two-stage approach entails a greater cumulative surgical burden. Patient- and treatment-related factors, including radiotherapy, bilateral surgery, BMI, and ASA score, significantly influence complication risk. These findings highlight the importance of individualized, risk-adapted patient selection when choosing the optimal reconstructive strategy.