Immediate Placement of Implants in Breast Reconstruction: Patient Selection and Outcomes

Abstract

With the advent of skin-sparing mastectomy techniques, it became clear that immediate placement of an implant could be utilized for breast reconstruction in select patients. The authors assessed the safety, patient selection factors, and aesthetic results with this technique. Thirty-five consecutive patients (eight unilateral and 27 bilateral) who underwent immediate implant-based breast reconstruction were analyzed. Patient data and complication rates were obtained from a retrospective chart review. Postoperative photographs were evaluated by a blinded panel and scored on a four-point scale. With a mean follow-up of 15 months, complications occurred in six patients (17.1 percent). There was one episode (2.9 percent) of skin necrosis resulting in implant loss, two episodes (5.7 percent) of postoperative infection, both of which resulted in implant salvage, and three patients who developed capsular contracture (8.5 percent). A total of 13 patients (37 percent) required additional surgery for revision. Revisions were necessary significantly more commonly in patients with a history of radiotherapy (p = 0.047), D-cup breast size or greater (p = 0.018), and ptosis of grade 2 or more (p = 0.017). The mean overall aesthetic score was 3.19, and upon subgroup analysis, patients with a history of radiation treatment (2.46), D-cup breast size or greater (2.64), and ptosis or grade 2 or more (2.98) had lower mean scores. Exclusion of these subgroups resulted in a mean score 3.39. Immediate implant-based breast reconstruction is a safe and viable option that can provide a very good aesthetic result in appropriately selected candidates. The authors recommend caution and appropriate patient counseling in patients with a history of radiotherapy, larger breasts, and/or ptotic breasts.