Stage Of Breast Reconstruction Research Articles

Staged breast reconstruction utilizing primary nipple repositioning surgery prior to nipple-sparing mastectomy

Staged nipple-sparing mastectomy (NSM) following mastopexy or breast reduction has become increasingly utilized in patients with large or ptotic breasts. The safety and efficacy of this approach has been demonstrated in recent years. However, the optimal timing between stages has not been established. The authors provide their experience with this staged approach with emphasis on timing between stages. An institutional review board approved this retrospective study. Data of all patients at a single institution who underwent staged NSM following mastopexy or reduction mammaplasty for therapeutic or prophylactic oncologic surgical management from 2016 to 2020 were reviewed. Timing between stages as well as surgical, oncologic, aesthetic, and patient-reported outcomes were evaluated. Nineteen patients (38 breasts) underwent staged NSM following planned mastopexy/breast reduction. The mean time interval between stages was 25weeks. No patients developed nipple areolar complex necrosis. Infection and hematoma were seen in one breast (2.6%) and seroma in two (5.3%) after NSM. Delayed wound healing was seen in eight breasts (21.1%) after first stage mastopexy/reduction and in 12 breasts (31.6%) after NSM. Skin flap necrosis was noted in two breasts (5.3%) after NSM. No patients developed oncological recurrence. Mean patient-reported post-operative satisfaction and well-being scores were 63 and 67 out of 100, respectively. The authors describe their experience with staged NSM following nipple repositioning procedures. Their results suggest that this procedure can be performed safely with cosmetically favorable results if surgeons wait an average of 25weeks between first and second stage procedures.

The Impact of Breast Implant Cohesivity on Rippling and Revision Procedures in 2-Stage Prepectoral Breast Reconstruction

Abstract Background Rippling remains one of the most common complications following prepectoral implant-based reconstruction (IBR). Objectives The purpose of this study was to assess how implant cohesivity, a measure of elasticity and form stability, affects the incidence of rippling in prepectoral IBR. Methods We performed a retrospective cohort study of 2-stage prepectoral IBR performed between January 2020 and June 2022 at the Brigham and Women's Hospital and Dana-Farber Cancer Institute, comparing outcomes in patients who received Allergan Natrelle least cohesive, moderately cohesive, and most cohesive silicone gel implants. Outcomes of interest were rippling and reoperation for fat grafting. Results A total of 129 patients were identified, of whom 52 had the least cohesive implants, 24 had the moderately cohesive implants, and 53 patients had the most cohesive implants. The mean follow-up time was 463 (±220) days. A decreased incidence of rippling was seen with moderately cohesive (odds ratio [OR] 0.30, P < .05) and most cohesive (OR 0.39, P < .05) implants. Third stage reoperation for fat grafting was less frequent in patients with the most cohesive implant (OR 0.07, P < .05). In subgroup analyses, the patients with the most cohesive implant, who did not receive fat grafting at the time of initial implant placement, did not require reoperation for fat grafting (0%). Conclusions The use of highly cohesive implants in prepectoral IBR is associated with decreased rippling and fewer reoperations for fat grafting. Level of Evidence: 3

Prepectoral Two-Stage Implant-Based Breast Reconstruction with Poly-4-Hydroxybutyrate for Pocket Control without the Use of Acellular Dermal Matrix: A 4-Year Review.

Absorbable mesh has been used to mitigate the potential drawbacks of acellular dermal matrix (ADM)-based breast reconstruction. Poly-4-hydroxybutyrate (P4HB) has been demonstrated to be a lower-cost, safe, and effective alternative to ADM in subpectoral breast reconstruction. In this study, the authors used P4HB for pocket control and implant support in immediate two-stage prepectoral breast reconstruction, examining nonintegration, capsular contracture, implant malposition, patient comorbidities, and risk factors. A retrospective review of a single surgeon's (K.M.) experience was performed over a 4-year span for patients who had undergone immediate two-stage prepectoral implant-based breast reconstruction with P4HB mesh. Complications (implant loss, rippling, capsular contracture, and malposition) and patient satisfaction were examined. From 2018 to 2022, 105 patients underwent breast reconstruction using P4HB mesh on a total of 194 breasts. P4HB mesh integration was 97%. Sixteen breasts (8.2%) experienced minor complications, and 10.3% of devices required explantation, which was significantly higher in the irradiated group at 28.6% ( P < 0.01). Patients who were older, had a higher body mass index, were active smokers, or had an increased mastectomy specimen size were more likely to undergo explantation. The capsular contracture rate and overall lateral malposition rate were 1.0%. Visible rippling was present in 15.6% of breasts. There was no significant difference between smile mastopexy and inferolateral incision with regard to capsular contracture, lateral malposition, and rippling. Overall, patients demonstrated a high level of satisfaction. There were no significant predictors of capsular contracture, lateral malposition, or visible rippling. The authors show the safety and efficacy of P4HB in two-stage prepectoral breast reconstruction. There appears to be equal, if not reduced, capsular contracture rates when compared with the published data on ADM. This represents a large cost reduction to both the patient and the health care system. Therapeutic, IV.

Examination of Sensory Recovery of Breasts Reconstructed With Silicone Breast Implants After Nipple-Sparing Mastectomy

Background: Reconstructed breast with silicone breast implants (SBIs) after nipple-sparing mastectomy (NSM) provides high patient satisfaction from a cosmetic point of view, but low patient satisfaction with respect to hypoesthesia of the reconstructed breast, and reinnervation is required. Currently, few reports are available on reinnervation in breast reconstruction with implants, and detailed data on desensitization of reconstructed breasts are lacking. Therefore, we examined perceptual data after NSM with respect to reinnervation. Methods: In our department, after NSM, tissue expander or SBI was used to perform 1-stage or 2-stage breast reconstruction, and touch, warm and cold, and pain sensations in 31 cases more than 1 year after completion of reconstruction were examined. Results: All tests of sensations tended to be better in the medial region than in the lateral region, but no correlation with postoperative years was found. In the comparison of the incision lines, in the Semmes-Weinstein monofilament test (SW test), a significant difference was observed between the inframammary fold (IMF) incision and the para-areola incision in the breast D region, between the lateral incision and the para-areola incision, and between the IMF incision and the para-areola incision in the areola b region. In addition, linear regression analysis of postoperative years did not establish a predictive formula for the SW test or pain sensation in any of the 9 regions. Conclusions: The difference in the excision range was considered to be the largest factor affecting hypoesthesia. We also speculated that preservation of the internal mammary artery perforators during mastectomy led to preservation of the anterior cutaneous branch of the intercostal nerves, and therefore, the perception of the medial region was better than that of the lateral region. In the case of NSM in which the anterior cutaneous branch was preserved, the recovery of outer perception including that of the nipple-areolar complex (NAC) was poor, so it was considered that nerve reconstruction between the lateral cutaneous branch and the NAC was effective for reinnervation.

Comparison of Complication Rates Between Subpectoral Vs Prepectoral Techniques in Prosthetic Breast Reconstruction.

The location of tissue expanders in implant-based breast reconstruction remains controversial, due to variation in surgical techniques and devices. This study aims to provide a comprehensive assessment of early and late complication rates between prepectoral and subpectoral placement of tissue expanders. A retrospective cohort study was conducted of all adult female patients who had two-staged implant-based breast reconstruction from 2013 to 2019 in our institution. Early complication was defined as complications that occurred within 30 days after surgery. Time-to-event analyses were performed and Cox proportional hazard models were used to adjust for confounders. 854 patients were included with 76% of patients underwent a subpectoral tissue expander placement. After the first stage procedure, the early complication rate was 34%, and the late complication rate was 36.4%. After the second stage procedure, the early complication rate was 16.3%, and the late complication rate was 16.1%. Location of the tissue expander did not predict either overall early or late complication rates, regardless of the stages of reconstruction, after adjusting for confounders. Tissue expanders placed in prepectoral plane were associated with a higher hazard ratio (HR) for developing early and late infection after the first stage of reconstruction (HR 2.1, HR 2.4, respectively) as well as late infection after the second stage of reconstruction (HR 5.3, all p<0.05). Location of tissue expanders did not predict risk of complication. However, the prepectoral group was associated with an increased risk of developing infection.

D104. Use Of SPY-QP To Predict Mastectomy Skin Flap Wound Complications in Immediate Breast Reconstruction

PURPOSE: SPY-QP® enables surgeons to assess relative perfusion quantitatively and in real-time; however, studies assessing its utility in predicting wound complications following breast reconstruction are limited. METHODS: Perfusion values were prospectively collected on patients undergoing staged breast reconstruction. There is currently no consensus on cut-off values for low perfusion, therefore the following values were used: 33% (reported by Moyer et al) and 30.0145% (calculated by the Youden index based on a logistic regression model). RESULTS: Twenty-four patients with 34 breasts underwent tissue expander (TE) placement at the time of mastectomy. SPY-QP was used after the TE was placed and filled with air to better reflect the postoperative state of the skin flaps. 4 breasts developed wound complications in areas with corresponding SPY-QP values of less than or equal to 30% (9.0-30.0%). The 33% cut-off yielded an odds ratio (OR) of 20.368 (95% CI: 0.9-450.7) for wound development, whereas the 30.0145% cut-off yielded an OR of 28.201 (95% CI: 1.3-632.8). When adjusted for nitroglycerin ointment usage, the OR was 16.827 (95% CI: 0.8-363.0), suggesting that it may interfere with wound development. CONCLUSION: SPY-QP® can safely predict wound development in breast reconstruction patients and guide clinical management of breast skin flaps. We suggest using a perfusion cut-off value of 30.0145%; however, larger, prospective studies are needed.

P231 Prepectoral versus subpectoral single stage breast reconstruction after conservative mastectomy for breast cancer: surgical and oncological outcomes

P231 Prepectoral versus subpectoral single stage breast reconstruction after conservative mastectomy for breast cancer: surgical and oncological outcomes

An Evaluation of Native Breast Dimension and Tissue Expander Inflation Rate on the Risk of Capsular Contracture Development in Postmastectomy Reconstruction.

Capsular contracture is a common complication after 2-stage breast reconstruction. The relationships between native breast size, the rate of tissue expander expansion, and capsule formation have not been elucidated. This study aims to evaluate how these factors contribute to capsular contracture and establish cutoff values for increased risk. A data set consisting of 229 patients who underwent 2-stage breast reconstruction between 2012 and 2021 was included in the study. The rate of expansion is estimated as the final expanded volume subtracted by the initial filling volume of the tissue expander over time elapsed. The native breast size was estimated using various preoperative breast measurements and the weight of mastectomy specimen (grams). Further stratified analysis evaluated patients separately based on postoperative radiation status. Greater nipple-inframammary fold distance and faster tissue expander enlargement rate conferred decreased odds of developing capsular contracture ( P < 0.05). On stratified analysis, faster tissue expansion rate was not significant in the nonradiated cohort but remained a significant negative predictor in the radiation group (odds ratio, 0.996; P < 0.05). Cut-point analysis showed an expansion rate of <240 mL/mo and a nipple-inframammary fold value of <10.5 cm as conferring a greater risk of capsular contracture. Smaller inframammary fold distance may be associated with a higher risk of capsular contracture. Slower expansion rates correlate with increased odds of contracture in patients undergoing adjuvant radiation. Breast geometry should be considered when risk stratifying various reconstruction approaches (implant vs autologous). In addition, longer delays between implant exchange and initial tissue expansion should be avoided if clinically feasible.

Timeline and Incidence of Postoperative Complications in Prepectoral, Dual-Plane, and Total Submuscular Alloplastic Reconstruction With and Without Biosynthetic Scaffold Usage.

Acellular dermal matrices and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over the surgical technique in implant-based breast reconstruction. The aims of this study are to compare various combinations of placement planes and biosynthetic scaffolds and to further examine the respective incidences of postoperative complications and the timeline of capsular contracture development. A data set consisting of 220 patients (393 samples) who underwent 2-stage reconstruction between 2012 and 2021 was used in the study. χ 2 , Fisher exact test, and 1-way analysis of variance were used to identify significant differences between the 4 subgroups. Cox proportional-hazards model and Kaplan-Meier estimator were used for survival analysis. On univariate logistic regression (odds ratio, 0.21; P = 0.005), survival analysis ( P = 0.0082), and Cox-proportional hazard model (hazard ratio, 1.6; P = 0.01), poly-4-hydroxybutyrate mesh usage was linked to an increased risk of capsular contracture development. Prepectoral placement with no mesh and dual-plane placement with acellular dermal matrix showed similar timelines of capsular contracture development. The lowest incidences of capsular contracture occurred in the prepectoral placement and no mesh (49/161, 30.4%) and total submuscular subgroups (3/14, 21.4%). Infection, necrosis, and revision surgery rates did not differ significantly between the 4 groups. The use of poly-4-hydroxybutyrate mesh in 2-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Prepectoral placement with no biosynthetic scaffold had one of the lowest rates of contracture and may provide the most optimal balance between economic and clinical considerations in implant-based reconstruction.

65 (PB-065) Poster - Quality of life and patient satisfaction after nipple sparing mastectomy versus skin sparing mastectomy and immediate one stage versus two stages breast reconstruction

Background: Nipple Sparing Mastectomy (NSM) and Skin Sparing Mastectomy (SSM) are oncologically safe procedures compared to classical modified radical mastectomy. This study evaluates whether NSM patients are more satisfied and have better quality of life than matched SSM patients and assesses patients’ quality of life after immediate one stage breast reconstruction with prepectoral permanent implants (IBR) compared to a matched group undergoing two stages breast reconstruction with expander and later with permanent implant.

The Fate of 2-stage Implant-based Breast Reconstruction in Patients with First Stage Complications: Predictors for Failure

The Fate of 2-stage Implant-based Breast Reconstruction in Patients with First Stage Complications: Predictors for Failure

Does the Final Implant Size Correlate with Complications? Putting Things into Perspective for a 2-stage Subpectoral Implant-based Breast Reconstruction

Does the Final Implant Size Correlate with Complications? Putting Things into Perspective for a 2-stage Subpectoral Implant-based Breast Reconstruction

Direct-to-Implant Breast Reconstruction After Unilateral and Bilateral Mastectomy: Cross-Sectional Study of Patient Satisfaction and Quality of Life with BREAST-Q.

Immediate single stage breast reconstruction is a challenging procedure with the goal of improving the quality of life of patients with breast cancer. The aim of this study is to evaluate using the BREAST-Q patient satisfaction, body perception and quality of life after direct-to-implant breast reconstruction comparing unilateral and bilateral reconstructions. In this study we enrolled 56 women who underwent mastectomy and immediate single-stage direct-to-implant (DTI) breast reconstruction at Campus Bio-Medico University of Rome between 2013 and 2020. One year after surgery they were administered electronically the BREAST-Q post-operative module. Our two cohorts of patients consisted in 34 women who received unilateral nipple-sparing mastectomy and DTI breast reconstruction and 22 women who underwent bilateral nipple-sparing mastectomy and DTI breast reconstruction. Twenty-four of the 34 patients belonging to the unilateral group responded to the questionnaire (70.5%), while in the bilateral group responders were 16 out of 22 (72.7%). The BREAST-Q scores were compared between the two groups: patients undergoing bilateral mastectomy and breast reconstruction showed higher scores in every BREAST-Q domain compared to patients undergoing unilateral mastectomy and breast reconstruction with a statistically significant difference in the Satisfaction with breast (P = 0.01), Sexual well-being (P = 0.03), and Satisfaction with implants (P = 0.01) domains. Patients undergoing bilateral DTI breast reconstruction have a favorable postoperative surgical cosmetic outcome with a better patient's body image perception and a higher post-operative level of satisfaction compared to unilateral DTI reconstruction after nipple-sparing mastectomy. 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.

Change of Gaze Pattern depending on the Stage of DIEP Flap Breast Reconstruction: a Preliminary Eye-Tracking Investigation

Breast reconstruction using autologous tissue is an integral part of breast cancer treatment. While many studies have elucidated the impact of breast reconstruction on patients' quality of life, self-esteem, sexuality and more, there is a lack of objective data regarding the effects on external observers. Aim of this study was to investigate the change in gaze pattern of independent observers depending on the stage of DIEP-flap breast reconstruction. Eye-tracking technology was utilized to analyze the eye movements of 58 study participants while viewing 2 D photographs of a patient after mastectomy and different stages of DIEP-flap breast reconstruction. Time until first fixation and total time of fixation were recorded and con- secutively analyzed for the right and left breast on each image. Overall, the total time of fixation of the operated breast decreased significantly over the different stages of breast reconstruction, with p<0.001. At the same time, there was no statistically significant change in total time of fixation of the non-operated breast, with p=0.174. The time until first fixation showed a significant increase over the different stages of reconstruction for the reconstructed breast, with p<0.001, while no significant differences were found for the opposite breast, with p=0.344. Mastectomy and the individual steps of breast reconstruction alter the perception of breast cancer patients. Over the course of breast reconstruction, the deviation of gaze in the direction of the affected breast is reversed.

Postmastectomy Radiation Therapy Bolus Associated Complications in Patients Who Underwent 2-stage Breast Reconstruction

PurposeThis study aimed to evaluate the association of bolus and 2-stage breast reconstruction complications, and whether the dosimetric advantage translates into improvements in local control. Methods and MaterialsWe retrospectively analyzed data from 2008 to 2019 of women who underwent a mastectomy and a planned 2-stage breast reconstruction, followed by adjuvant radiation therapy. We reviewed all data from medical records and radiation plans regarding patient characteristics, diagnoses, surgeries, complications, pathology, staging, systemic therapy, radiation therapy, and outcomes, and compared complication rates according to bolus usage. ResultsA total of 288 women, age 25 to 71 years, were included in the study. Of these women, 6 were treated with daily bolus and 19 with alternate days bolus, totaling 25 of 288 patients (8.7%) in the bolus group. A total of 226 patients (78.5%) had the second stage performed. The median follow-up time was 61 months. The rates for 5-year overall survival and locoregional control were both 97%, and the metastasis-free rate was 83%. In the first stage, 6.25% of patients in the entire cohort had an infection and 4.2% had implant loss. Daily bolus significantly increased the risk of expander infection (hazard ratio [HR]: 10.3; 95% confidence interval [CI], 1.7-61.8) and loss (HR: 13.89; 95% CI, 2.24-85.98), but alternate-day bolus showed a nonsignificant increase for expander infection (HR: 1.14; 95% CI, 0.14-9.295) and loss (HR: 1.5; 95% CI, 0.19-12.87). Bolus was not associated with second-stage complications or local-regional failure. Local infection and implant loss were more frequent in the second than in the first stage (5.2% vs 10.2% and 4.2% vs 12.8%, respectively). ConclusionsSkin bolus significantly increased first-stage breast reconstruction complications (infection and reconstruction failure). Despite the small sample size and the need for future studies, these findings need to be taken into consideration when planning treatment and reconstruction, and recommendations should be individualized.

Role of intercostal neurovascular perforator in lower abdominal flap

To investigate if intercostal neurovascular perforator can nourish lower abdominal flap. Between June 2017 and December 2020, in 39 female patients with predominant perforator originated from intercostal nerve nutrient vessels, main trunk of the deep inferior epigastric vessels was chosen to be the pedicle to harvest free lower abdominal flap for breast reconstruction. The age of the patients ranged from 28 to 52 years, with an average of 38.6 years. There were 16 cases on the left and 23 cases on the right. The duration of breast cancer was 3-32 months, with an average of 21.8 months. Pathological stage was stageⅡin 31 cases and stage Ⅲ in 8 cases. Among them, 25 cases were primary tumor resection and one stage breast reconstruction and 14 cases were delayed breast reconstruction. The lower abdominal flap pedicled with one side pedicle was harvested in 32 cases, all of which were supplied by the main trunk of the deep inferior epigastric vessel combined with the intercostal neurovascular perforator; 7 cases were harvested with bilateral pedicled lower abdominal flaps, of which 4 cases were supplied by the main trunk of the deep inferior epigastric vessel combined with intercostal neurovascular perforator on one side and deep inferior epigastric artery perforator on the other side, and the other 3 cases were supplied by bilateral main trunk of the deep inferior epigastric vessel and the intercostal neurovascular perforator. In the flaps nourished with the main trunk of the deep inferior epigastric vessel combined with the intercostal neurovascular perforator, the intercostal neurovascular perforators were one branch type in 15 cases, one branch+reticular type in 19 sides, and reticular type in 8 sides. The size of flap ranged from 26 cm×10 cm to 31 cm×13 cm; the thickness was 2.5-5.5 cm (mean, 2.9 cm); the vascular pedicle length was 7.0-11.5 cm (mean, 9.2 cm); the weight of the flap was 350-420 g (mean, 390 g). All the flaps survived completely and the incisions at donor sites healed by first intention. All patients were followed up 14-35 months (mean, 25.4 months). The shape, texture, and elasticity of reconstructed breasts were good and no flap contracture happened. Only linear scar left at the donor site, the function of abdomen was not affected. No local recurrence happened. When the direct perforator of the deep inferior epigastric artery may not provide reliable blood supply for the lower abdominal flap, the intercostal neurovascular perforator with deep inferior epigastric vessels can ensure the blood supply of the free lower abdominal flap.

The "Smile Mastopexy": A Novel Technique to Aesthetically Address the Excess Skin Envelope in Large, Ptotic Breasts While Preserving Nipple Areolar Complex During Prosthetic Breast Reconstruction.

Classically large, ptotic breasts have been a contraindication for nipple preservation during breast reconstruction. We present a technique of "smile mastopexy" (SM) to reduce the excess skin in both vertical and transverse directions, avoid a T-junction, preserve the nipple areolar complex, and add thickness to the upper pole of the breast at the time of mastectomy. The authors sought to demonstrate the safety and reliability of a novel technique that addresses the excess skin envelope during breast reconstruction while preserving the nipple-areola complex in large, ptotic breasts. This is a retrospective review of a single surgeon performing the SM for immediate 2-stage prosthetic breast reconstruction. All were performed in the prepectoral pocket without utilization of acellular dermal matrices. Thirty patients (total 54 breasts) aged a mean 50 years with BMI of 30 kg/m2 and mastectomy specimen weight of 683 g were included. All had class 2 or 3 ptosis. There were no cases of complete nipple loss. The overall complication rate was 14.8%. There were 3 explantations: 1 (1.8%) due to infection and 2 (3.7%) due to implant exposure. Radiation was associated with a higher complication rate. The SM is a safe and reliable technique in large, ptotic breasts during prosthetic breast reconstruction. It preserves the nipple-areola complex, reduces the excess skin envelope, adds thickness to the upper pole, and allows for future skin revisions with the same scar if necessary.

Single stage breast reconstruction - a district hospital experience in 2020

Background: Acellular dermal matrices are grafts created by decellularisation of tissue and leaving only the extracellular matrix and collagen scaffold. Reported advantages include better control and definition of implant pocket and inframamary fold, control of lower pole projection, less rippling, reduced capsule formation and decreased possibility of implant migration. Reported complications include seroma formation , infection, skin necrosis and higher cost.

Clinical use of perioperative magnetic resonance imaging-based breast volumetric analysis in final implant volume prediction for two-stage breast reconstruction.

PurposeBreast volume is an important factor in breast reconstruction; however, the surgeon is expected to deliver the volume expectation with his aesthetic inspiration. Therefore, objective volumetry must be developed. This study aimed to conduct an MRI-based breast volumetric analysis. With periodic analysis of 2-stage breast reconstruction, we suggest the possibility of clinical use of breast volumetry in implant volume prediction.MethodsThis retrospective study included 140 patients who underwent unilateral 2-stage breast reconstruction (tissue expander followed by implant insertion) between January 1, 2017 and December 31, 2019. The MRI image was converted into a 3-dimensional image with a reconstruction program (A-VIEW, Coreline Soft). MRI image was obtained before the surgery and then at 1, 3, 6, 12, and 24 months postoperatively. The volume was automatically calculated.ResultsCompared with the preoperative volume, maximized volume and differences were noted at 1 month and minimized at 1 year. The correlation between MRI-based preoperative breast volumetry and the mastectomy specimen volume was 0.611. Volume difference between the MRI-based preoperative state and the implant volume showed a minimal difference at 1 year. The final implant size prediction formula was calculated using the 1-year postoperative volume (P < 0.001, R2 = 0.594).ConclusionTo avoid breast reconstruction based solely on the surgeon’s subjective assessment, MRI-based breast volumetry could be a useful method to develop more scientific and objective breast reconstruction planning. We suggest a volume prediction formula that describes the relationship between the postoperative breast volume and the final breast implant size.

Does Higher Intraoperative Fraction of Inspired Oxygen Improve Complication Rates Following Implant-Based Breast Reconstruction?

BackgroundThe surgical literature debates about whether an average intraoperative fractional inspired level of oxygen (FiO2) greater than 80% confers lower postsurgical complication rates. Although some evidence demonstrates minimal or no difference in short-term mortality or surgical site infections, few studies suggest negative long-term outcomes.ObjectivesTo the best of our knowledge, this is the first study examining the relationship between intraoperative FiO2 levels and postoperative outcomes in the setting of immediate prepectoral implant-based breast reconstruction.MethodsThe authors retrospectively reviewed the complication profiles of 309 patients who underwent prepectoral 2-stage breast reconstruction following mastectomy between 2018 and 2021 at a single institution. Two cohorts were created based on whether intraoperative FiO2 was greater than 80% or less than or equal to 80%. Complication rates between the cohorts were analyzed using Chi-squared test, Fisher’s exact test, and multivariable logistic regressions. Variables examined included demographic information; smoking history; preexisting comorbidities; history of chemotherapy, radiation, or axillary lymph node dissection; and perioperative information. ResultsChi-squared and multivariable regression analysis demonstrated no significant difference between cohorts in complication rates other than reoperation. Reoperation rates were significantly increased in the FiO2 greater than 80% cohort (P = 0.018). Multivariable logistic regression also demonstrated that the use of acellular dermal matrix was significantly associated with increased postoperative complications (odds ratio 11.985; P = 0.034).ConclusionsComplication rates did not statistically differ in patients with varying intraoperative FiO2 levels outside of reoperation rates. In the setting of implant-based prepectoral breast reconstruction, hyperoxygenation likely does not lead to improved postsurgical outcomes.Level of Evidence: 3