Evaluation of Modifications to Tissue-Expander Breast Reconstruction, a Quality Improvement Assessment Within a Private Practice.

Abstract

As technology advances, surgical practice evolves over time. The author assesses a new approach to implant-based breast reconstruction and the impact of two changes implemented over several years. A series of tissue-expander reconstructions performed early in the author's experience were retrospectively compared with a similar number of cases prospectively performed. Demographics, perioperative characteristics, and postoperative outcomes were assessed. Fifty-three patients (87 breasts) were analyzed, 29 treated earlier with one of the early acellular dermal matrices (ADMs) available and 24 current cases using a no-touch operative approach and pliable, perforated ADM. Demographics and perioperative characteristics between the cohorts were comparable. Mean age was 47.6 years, body mass index (BMI) of 25.8 and 18.9% had current or former nicotine use. Immediate reconstruction was performed in 75 (86.2%) breasts. Drains remained in situ 16 ± 8.9 days, with a significantly lower number of days required in latter patients. At a mean follow-up of 9.6 months, complications included early capsular thickening in 7 (13.2%) patients requiring capsulectomy at the second stage exchange surgery, prosthetic (expander) removal in 3 (3.4%) breasts, significant infection requiring intervention in 3 (5.7%) patients, seroma in 3 (5.7%) patients, 2 (3.8%) cases of wound dehiscence, and 1 (1.9%) case of flap necrosis and hematoma. Incomplete ADM incorporation was observed in 9 (10.3%) breasts. Three reconstructive failures occurred in the early cohort. Patients in the later cohort reported significantly improved BREAST-Q scores (P < 0.005) postoperatively with a high level of satisfaction. Using a no-touch technique and an ADM designed with functional characteristics advantageous to breast reconstructive surgery appears to have improved patient outcomes.