Plastic Surgery Research Council
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Presenter: Ingrid Ganske, MD
Co-Authors: Susarla S; Helliwell L; Morris D; Eriksson E; Chun Y
Brigham and Women's Hospital

Purpose: To compare clinical outcomes and patient satisfaction between immediate single-stage versus two-stage (tissue expander and subsequent implant placement) implant-based breast reconstructions.

Methods: A retrospective analysis of consecutive immediate breast reconstructions over an 8-year period (2002-2009) was performed. A total of 582 reconstructions in 396 patients were divided into either single-stage or two-stage implant-based reconstructions. Demographic information, co-morbidities, oncologic data, and complications were collected for comparison. Patient satisfaction across multiple domains was assessed by the Breast-Q survey instrument. Descriptive, bivariate and multiple regression statistics were computed. P-values <0.05 were considered significant.

Results: 166 reconstructions were performed as single-stage implant-based reconstruction and 416 were performed as two-stage TE/implant-based reconstruction. Upon comparing the single- and two-stage groups, there were no significant differences in the rate of post-operative complications including minor infections (0% vs. 1.0%, p=0.120), major infections (4.0% vs. 4.0%, p=0.84), hematoma (2.0% vs. 2.0%, p=0.79), seroma (4.0% vs. 6.0%, p=0.52), and minor (3.0 vs. 6.0%, p=0.20) or major (13.0% vs. 13.0%, p=0.96) skin necrosis. 45% of the single-stage reconstructions underwent revision. Analysis of the Breast-Q survey data from 268 reconstructions (65 single-stage; 203 two-stage) showed higher satisfaction scores with sexual well-being in the single-stage group, while higher satisfaction with information, surgeon, medical and office staff was observed in the two-stage group (p<0.001).

Conclusion: There were no significant differences in complication rates or overall patient satisfaction between immediate single-stage versus two-stage implant-based breast reconstructions. Patients with single-stage reconstructions had higher sexual well-being scores, potentially related to psychosocial effects of immediate reconstruction. Higher satisfaction with medical staff in two-stage reconstruction may be related to the routine visits inherent in the expansion process.

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