Seldom one and done: Characterizing rates of reoperation with direct-to-implant breast reconstruction after mastectomy

Jacob B. Hammond; Brittany M. Foley; Heidi E. Kosiorek; Patricia A. Cronin; Alanna M. Rebecca; William J. Casey; Erwin A. Kruger; Chad M. Teven; Barbara A. Pockaj

doi:10.1016/j.amjsurg.2022.04.011

Seldom one and done: Characterizing rates of reoperation with direct-to-implant breast reconstruction after mastectomy

Jacob B. Hammond, Brittany M. Foley, Heidi E. Kosiorek, Patricia A. Cronin, Alanna M. Rebecca, William J. Casey, Erwin A. Kruger, Chad M. Teven, Barbara A. Pockaj

General Surgery

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Limited data exist outlining reoperations after direct-to-implant (DTI), tissue expander (TE) and autologous free-flap breast reconstruction. Methods: Patients undergoing mastectomy with reconstruction from 2008 to 18 were reviewed. Patient factors, surgical techniques, planned, unplanned, and total reoperations were analyzed. Results: Among 544 total patients, the majority underwent DTI (294, 54%) or TE (176, 32%); 74 (14%) received autologous free-flaps. Majority of DTI patients (55%) underwent subsequent reoperations. Compared to autologous tissue, DTI had less patients undergo additional surgery (76% vs. 55%, P = 0.001). Incidence of total unplanned reoperations did not significantly differ between reconstructive groups. The rate of unplanned reoperations due to complications was lowest for DTI (39%) when compared to TE (48%) and autologous (55%, P = 0.015). Compared to TE, DTI carried a lower risk for ≥2 total reoperations (OR = 0.21, 95% CI 0.13–0.33, P < 0.001). Conclusions: Seldom “one and done,” additional surgery after DTI remains significant.

Original language	English (US)
Pages (from-to)	141-146
Number of pages	6
Journal	American journal of surgery
Volume	224
Issue number	1
DOIs	https://doi.org/10.1016/j.amjsurg.2022.04.011
State	Published - Jul 2022

Keywords

Breast cancer
Breast reconstruction
Direct-to-implant
Mastectomy
Revisions

ASJC Scopus subject areas

Surgery

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10.1016/j.amjsurg.2022.04.011

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title = "Seldom one and done: Characterizing rates of reoperation with direct-to-implant breast reconstruction after mastectomy",

abstract = "Background: Limited data exist outlining reoperations after direct-to-implant (DTI), tissue expander (TE) and autologous free-flap breast reconstruction. Methods: Patients undergoing mastectomy with reconstruction from 2008 to 18 were reviewed. Patient factors, surgical techniques, planned, unplanned, and total reoperations were analyzed. Results: Among 544 total patients, the majority underwent DTI (294, 54%) or TE (176, 32%); 74 (14%) received autologous free-flaps. Majority of DTI patients (55%) underwent subsequent reoperations. Compared to autologous tissue, DTI had less patients undergo additional surgery (76% vs. 55%, P = 0.001). Incidence of total unplanned reoperations did not significantly differ between reconstructive groups. The rate of unplanned reoperations due to complications was lowest for DTI (39%) when compared to TE (48%) and autologous (55%, P = 0.015). Compared to TE, DTI carried a lower risk for ≥2 total reoperations (OR = 0.21, 95% CI 0.13–0.33, P < 0.001). Conclusions: Seldom “one and done,” additional surgery after DTI remains significant.",

keywords = "Breast cancer, Breast reconstruction, Direct-to-implant, Mastectomy, Revisions",

author = "Hammond, {Jacob B.} and Foley, {Brittany M.} and Kosiorek, {Heidi E.} and Cronin, {Patricia A.} and Rebecca, {Alanna M.} and Casey, {William J.} and Kruger, {Erwin A.} and Teven, {Chad M.} and Pockaj, {Barbara A.}",

note = "Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

month = jul,

doi = "10.1016/j.amjsurg.2022.04.011",

language = "English (US)",

volume = "224",

pages = "141--146",

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issn = "0002-9610",

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T1 - Seldom one and done

T2 - Characterizing rates of reoperation with direct-to-implant breast reconstruction after mastectomy

AU - Hammond, Jacob B.

AU - Foley, Brittany M.

AU - Kosiorek, Heidi E.

AU - Cronin, Patricia A.

AU - Rebecca, Alanna M.

AU - Casey, William J.

AU - Kruger, Erwin A.

AU - Teven, Chad M.

AU - Pockaj, Barbara A.

PY - 2022/7

Y1 - 2022/7

N2 - Background: Limited data exist outlining reoperations after direct-to-implant (DTI), tissue expander (TE) and autologous free-flap breast reconstruction. Methods: Patients undergoing mastectomy with reconstruction from 2008 to 18 were reviewed. Patient factors, surgical techniques, planned, unplanned, and total reoperations were analyzed. Results: Among 544 total patients, the majority underwent DTI (294, 54%) or TE (176, 32%); 74 (14%) received autologous free-flaps. Majority of DTI patients (55%) underwent subsequent reoperations. Compared to autologous tissue, DTI had less patients undergo additional surgery (76% vs. 55%, P = 0.001). Incidence of total unplanned reoperations did not significantly differ between reconstructive groups. The rate of unplanned reoperations due to complications was lowest for DTI (39%) when compared to TE (48%) and autologous (55%, P = 0.015). Compared to TE, DTI carried a lower risk for ≥2 total reoperations (OR = 0.21, 95% CI 0.13–0.33, P < 0.001). Conclusions: Seldom “one and done,” additional surgery after DTI remains significant.

AB - Background: Limited data exist outlining reoperations after direct-to-implant (DTI), tissue expander (TE) and autologous free-flap breast reconstruction. Methods: Patients undergoing mastectomy with reconstruction from 2008 to 18 were reviewed. Patient factors, surgical techniques, planned, unplanned, and total reoperations were analyzed. Results: Among 544 total patients, the majority underwent DTI (294, 54%) or TE (176, 32%); 74 (14%) received autologous free-flaps. Majority of DTI patients (55%) underwent subsequent reoperations. Compared to autologous tissue, DTI had less patients undergo additional surgery (76% vs. 55%, P = 0.001). Incidence of total unplanned reoperations did not significantly differ between reconstructive groups. The rate of unplanned reoperations due to complications was lowest for DTI (39%) when compared to TE (48%) and autologous (55%, P = 0.015). Compared to TE, DTI carried a lower risk for ≥2 total reoperations (OR = 0.21, 95% CI 0.13–0.33, P < 0.001). Conclusions: Seldom “one and done,” additional surgery after DTI remains significant.

KW - Breast cancer

KW - Breast reconstruction

KW - Direct-to-implant

KW - Mastectomy

KW - Revisions

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Seldom one and done: Characterizing rates of reoperation with direct-to-implant breast reconstruction after mastectomy

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Keywords

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