Biological Matrix-Assisted One-Stage Implant-Based Breast Reconstruction Versus Two-Stage Implant-Based Breast Reconstruction: Patient-Reported Outcomes and Complications

Less is more? One-stage versus two-stage implant-based breast reconstruction: A systematic review and meta-analysis of comparative studies

BACKGROUND

Most breast reconstructions are implant-based and can be performed either in a one-stage, direct-to-implant or in a two-stage, expander-implant-based reconstruction. The objective of this systematic review is to compare the safety and patient satisfaction of the two reconstruction approaches.

METHODS

A literature search was conducted on 27 September 2022 using various databases. Studies comparing one-stage and two-stage implant reconstructions and reporting the following outcomes were included: patient satisfaction, aesthetics, complications, and/or costs. Reviews, case reports, or series with less than 20 patients and letters or comments were excluded. Comparisons were made between the one-stage reconstruction with and without acellular dermal matrix (ADM) and two-stage implant-based breast reconstruction groups. The data extracted from all articles were analysed using random-effects meta-analyses.

RESULTS

Of the 1381 records identified, a total of 33 articles were included, representing 21529 patients. There were no significant differences between the one-stage and two-stage groups, except for the costs. The one-stage operation without ADM had lower costs than the two-stage operation without ADM, although the use of an ADM substantially increased the price of the operation to more than a two-stage reconstruction.

DISCUSSION

Equal patient satisfaction, aesthetic outcomes, and complication rates with lower costs justify one-stage breast reconstruction in carefully selected patients. This review shows that there is no evidence-based superior surgical approach. Future research should focus on the costs of the ADM versus an additional stage and patient-reported outcomes.

Revision Rate of Direct-to-Implant Breast Reconstruction: Is it Truly a Single-Stage Reconstruction? A Single-Surgeon Experience

INTRODUCTION

There has been increased interest in direct-to-implant (DTI) reconstruction in recent years. The goal of this study was to focus on the re-operation rate of DTI in comparison with two-stage tissue expander (TE) reconstruction.

PATIENTS AND METHODS

In total, 165 consecutive patients (222 breasts) underwent skin sparing mastectomy and immediate implant-based reconstruction between January 2010 and December 2019. Patients were divided to TE procedure and DTI (42,180 breasts, respectively). Data collected included demographics, operative details and oncological medical treatment, complications classified according to Clavien-Dindo, capsular contracture Baker 3-4 and re-operation due to complication or due to patient's wish to improve aesthetic appearance.

RESULTS

There were significantly more prophylactic mastectomies and BRCA gene mutation in the DTI breast reconstruction group, and more smokers and diabetic patients in the TE group. No significant difference was found in the complication rates between the groups (DTI-26.1%, TE-40.5%). However, major complication and re-operation rate due to complications were significantly different ( DTI-16.7% and 10.6%, TE-26.2% and 31%, respectively, p= 0.035, p = 0.008). No significant differences were found in Clavien-Dindo stages between the groups except for Grade 3b. Re-operation due to desire for aesthetic improvement was significantly higher in the TE group (DTI-38%. TE-69%, p=0.0003).

CONCLUSION

DTI immediate breast reconstruction can provide a good alternative to the traditional two-stage TE/implant operation. Both patients and surgeons can be reassured that the majority of the cases are one-stage reconstruction.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Trends and issues in clinical research on satisfaction and quality of life after mastectomy and breast reconstruction: a 5-year scoping review

Breast reconstruction (BR) aims to improve the satisfaction and quality of life (QOL) of breast cancer survivors. Clinical studies using patient-reported outcomes (PROs) can therefore provide relevant information to the patients and support decision-making. This scoping review was conducted to analyze recent trends in world regions, methods used, and factors investigated. The literature search was conducted in August 2022. Databases of PubMed, MEDLINE, and CINAHL were searched for relevant English-language studies published from 2017 to 2022. Studies involving women with breast cancer who underwent BR after mastectomy and investigated PROs after BR using BR-specific scales were included. Data on the country, publication year, study design, PRO measures (PROMs) used, time points of surveys, and research themes were collected. In total, 147 articles met the inclusion criteria. BREAST-Q was the most widely used, contributing to the increase in the number and diversification of studies in this area. Such research has been conducted mainly in North America and Europe and is still developing in Asia and other regions. The research themes involved a wide range of clinical and patient factors in addition to surgery, which could be influenced by research methods, time since surgery, and even cultural differences. Recent BR-specific PROMs have led to a worldwide development of research on factors that affect satisfaction and QOL after BR. PRO after BR may be influenced by local cultural and social features, and it would be necessary to accumulate data in each region to draw clinically useful conclusion.