Reducing Expansion Visits in Immediate Implant-Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement
The numerous office visits required to complete expansion in implant-based breast reconstruction impact patient satisfaction, office resources, and time to complete reconstruction. This study aimed to determine whether prepectoral compared to subpectoral immediate implant-based breast reconstruction...
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| Veröffentlicht in: | Plastic and reconstructive surgery (1963) 2019-08, Vol.144 (2), p.276-286 |
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| creator | Wormer, Blair A. Valmadrid, Al C. Ganesh Kumar, Nishant Al Kassis, Salam Rankin, Timothy M. Kaoutzanis, Christodoulos Higdon, Kent K. |
| description | The numerous office visits required to complete expansion in implant-based breast reconstruction impact patient satisfaction, office resources, and time to complete reconstruction. This study aimed to determine whether prepectoral compared to subpectoral immediate implant-based breast reconstruction offers expedited tissue expansion without affecting complication rates.
Consecutive patients who underwent immediate implant-based breast reconstruction with tissue expanders from January of 2016 to July of 2017 by a single surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral (complete acellular dermal matrix coverage), and reviewed. The primary outcomes were total days and number of visits to complete expansion. Groups were compared by univariate analysis with significance set at p < 0.05.
In total, 101 patients (subpectoral, n = 69; prepectoral, n = 32) underwent 184 immediate implant-based breast reconstructions (subpectoral, n = 124; prepectoral, n = 60). There was no difference in age, body mass index, smoking, or diabetes between the groups (all p > 0.05). Follow-up was similar between groups (179.3 ± 98.2 days versus 218.3 ± 119.8 days; p = 0.115). Prepectoral patients took fewer days to complete expansion (40.4 ± 37.8 days versus 62.5 ± 50.2 days; p < 0.001) and fewer office visits to complete expansion (2.3 ± 1 .7 versus 3.9 ± 1.8; p < 0.001), and were expanded to greater final volumes than subpectoral patients (543.7 ± 122.9 ml versus 477.5 ± 159.6 ml; p = 0.017). Between prepectoral and subpectoral reconstructions, there were similar rates of minor complications (25 percent versus 18.5 percent; p = 0.311), readmissions (5 percent versus 2.4 percent; p = 0.393), seromas (8.3 percent versus 5.6 percent; p = 0.489), reoperations for hematoma (3.3 percent versus 1.6 percent; p = 0.597), and explantations (5 percent versus 2.4 percent; p = 0.393).
This novel analysis demonstrates that prepectoral immediate implant-based breast reconstruction can facilitate expansion to higher total volumes in nearly half the office visits compared to subpectoral placement in similar populations without increasing complication rates.
Therapeutic, III. |
| doi_str_mv | 10.1097/PRS.0000000000005791 |
| format | Article |
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Consecutive patients who underwent immediate implant-based breast reconstruction with tissue expanders from January of 2016 to July of 2017 by a single surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral (complete acellular dermal matrix coverage), and reviewed. The primary outcomes were total days and number of visits to complete expansion. Groups were compared by univariate analysis with significance set at p < 0.05.
In total, 101 patients (subpectoral, n = 69; prepectoral, n = 32) underwent 184 immediate implant-based breast reconstructions (subpectoral, n = 124; prepectoral, n = 60). There was no difference in age, body mass index, smoking, or diabetes between the groups (all p > 0.05). Follow-up was similar between groups (179.3 ± 98.2 days versus 218.3 ± 119.8 days; p = 0.115). Prepectoral patients took fewer days to complete expansion (40.4 ± 37.8 days versus 62.5 ± 50.2 days; p < 0.001) and fewer office visits to complete expansion (2.3 ± 1 .7 versus 3.9 ± 1.8; p < 0.001), and were expanded to greater final volumes than subpectoral patients (543.7 ± 122.9 ml versus 477.5 ± 159.6 ml; p = 0.017). Between prepectoral and subpectoral reconstructions, there were similar rates of minor complications (25 percent versus 18.5 percent; p = 0.311), readmissions (5 percent versus 2.4 percent; p = 0.393), seromas (8.3 percent versus 5.6 percent; p = 0.489), reoperations for hematoma (3.3 percent versus 1.6 percent; p = 0.597), and explantations (5 percent versus 2.4 percent; p = 0.393).
This novel analysis demonstrates that prepectoral immediate implant-based breast reconstruction can facilitate expansion to higher total volumes in nearly half the office visits compared to subpectoral placement in similar populations without increasing complication rates.
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Consecutive patients who underwent immediate implant-based breast reconstruction with tissue expanders from January of 2016 to July of 2017 by a single surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral (complete acellular dermal matrix coverage), and reviewed. The primary outcomes were total days and number of visits to complete expansion. Groups were compared by univariate analysis with significance set at p < 0.05.
In total, 101 patients (subpectoral, n = 69; prepectoral, n = 32) underwent 184 immediate implant-based breast reconstructions (subpectoral, n = 124; prepectoral, n = 60). There was no difference in age, body mass index, smoking, or diabetes between the groups (all p > 0.05). Follow-up was similar between groups (179.3 ± 98.2 days versus 218.3 ± 119.8 days; p = 0.115). Prepectoral patients took fewer days to complete expansion (40.4 ± 37.8 days versus 62.5 ± 50.2 days; p < 0.001) and fewer office visits to complete expansion (2.3 ± 1 .7 versus 3.9 ± 1.8; p < 0.001), and were expanded to greater final volumes than subpectoral patients (543.7 ± 122.9 ml versus 477.5 ± 159.6 ml; p = 0.017). Between prepectoral and subpectoral reconstructions, there were similar rates of minor complications (25 percent versus 18.5 percent; p = 0.311), readmissions (5 percent versus 2.4 percent; p = 0.393), seromas (8.3 percent versus 5.6 percent; p = 0.489), reoperations for hematoma (3.3 percent versus 1.6 percent; p = 0.597), and explantations (5 percent versus 2.4 percent; p = 0.393).
This novel analysis demonstrates that prepectoral immediate implant-based breast reconstruction can facilitate expansion to higher total volumes in nearly half the office visits compared to subpectoral placement in similar populations without increasing complication rates.
Therapeutic, III.</description><subject>Acellular Dermis</subject><subject>Breast Implantation - instrumentation</subject><subject>Breast Implantation - methods</subject><subject>Breast Implants</subject><subject>Breast Neoplasms - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Office Visits - statistics & numerical data</subject><subject>Operative Time</subject><subject>Postoperative Complications - etiology</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Tissue Expansion - instrumentation</subject><subject>Tissue Expansion - methods</subject><subject>Tissue Expansion Devices</subject><issn>0032-1052</issn><issn>1529-4242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUctu1TAQtRCIXgp_gJCXbFL8iOOEXXtVoFKlXt0LbKOJPaGGJA6209LP4I9xn1SdjWd85pyx5xDylrMDzhr9YbPdHbBHoXTDn5EVV6IpSlGK52TFmBQFZ0rskVcx_mSMa1mpl2RPclnWUlQr8neLdjFu-kGP_8wwRecn-t1FlyJ1Ez0ZR7QOEuZsHmBKxRFEtPQoIMREt2j8FFNYTMq8j_SQrv04Q4DkLpDu0mKvqO_pJuCMJvkAA4XJ0t3SPdQ3Uy0GuhnA4IhTek1e9DBEfHN37pNvn46_rr8Up2efT9aHp4WRSohCmrpuhIZOcFNi3wCrLdeW11hW3HRlpWsJWmGterB1Rlkle2hkxsACdnKfvL_VnYP_vWBM7eiiwSF_E_0SWyEqpbVuNM-t5W2rCT7GgH07BzdCuGo5a6_NaLMZ7VMzMu3d3YSly3t8IN1v_7_upR8ShvhrWC4xtOcIQzq_0auULAvBeJPfz1hxfSXkP_Fjlxc</recordid><startdate>20190801</startdate><enddate>20190801</enddate><creator>Wormer, Blair A.</creator><creator>Valmadrid, Al C.</creator><creator>Ganesh Kumar, Nishant</creator><creator>Al Kassis, Salam</creator><creator>Rankin, Timothy M.</creator><creator>Kaoutzanis, Christodoulos</creator><creator>Higdon, Kent K.</creator><general>by the American Society of Plastic Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190801</creationdate><title>Reducing Expansion Visits in Immediate Implant-Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement</title><author>Wormer, Blair A. ; Valmadrid, Al C. ; Ganesh Kumar, Nishant ; Al Kassis, Salam ; Rankin, Timothy M. ; Kaoutzanis, Christodoulos ; Higdon, Kent K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3522-3c88927ab21c4ef9a08d17d18e461cb46783a75e85fad8a08063fa931cbadaeb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acellular Dermis</topic><topic>Breast Implantation - instrumentation</topic><topic>Breast Implantation - methods</topic><topic>Breast Implants</topic><topic>Breast Neoplasms - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Office Visits - statistics & numerical data</topic><topic>Operative Time</topic><topic>Postoperative Complications - etiology</topic><topic>Reoperation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Tissue Expansion - instrumentation</topic><topic>Tissue Expansion - methods</topic><topic>Tissue Expansion Devices</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wormer, Blair A.</creatorcontrib><creatorcontrib>Valmadrid, Al C.</creatorcontrib><creatorcontrib>Ganesh Kumar, Nishant</creatorcontrib><creatorcontrib>Al Kassis, Salam</creatorcontrib><creatorcontrib>Rankin, Timothy M.</creatorcontrib><creatorcontrib>Kaoutzanis, Christodoulos</creatorcontrib><creatorcontrib>Higdon, Kent K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Plastic and reconstructive surgery (1963)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wormer, Blair A.</au><au>Valmadrid, Al C.</au><au>Ganesh Kumar, Nishant</au><au>Al Kassis, Salam</au><au>Rankin, Timothy M.</au><au>Kaoutzanis, Christodoulos</au><au>Higdon, Kent K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reducing Expansion Visits in Immediate Implant-Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement</atitle><jtitle>Plastic and reconstructive surgery (1963)</jtitle><addtitle>Plast Reconstr Surg</addtitle><date>2019-08-01</date><risdate>2019</risdate><volume>144</volume><issue>2</issue><spage>276</spage><epage>286</epage><pages>276-286</pages><issn>0032-1052</issn><eissn>1529-4242</eissn><abstract>The numerous office visits required to complete expansion in implant-based breast reconstruction impact patient satisfaction, office resources, and time to complete reconstruction. This study aimed to determine whether prepectoral compared to subpectoral immediate implant-based breast reconstruction offers expedited tissue expansion without affecting complication rates.
Consecutive patients who underwent immediate implant-based breast reconstruction with tissue expanders from January of 2016 to July of 2017 by a single surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral (complete acellular dermal matrix coverage), and reviewed. The primary outcomes were total days and number of visits to complete expansion. Groups were compared by univariate analysis with significance set at p < 0.05.
In total, 101 patients (subpectoral, n = 69; prepectoral, n = 32) underwent 184 immediate implant-based breast reconstructions (subpectoral, n = 124; prepectoral, n = 60). There was no difference in age, body mass index, smoking, or diabetes between the groups (all p > 0.05). Follow-up was similar between groups (179.3 ± 98.2 days versus 218.3 ± 119.8 days; p = 0.115). Prepectoral patients took fewer days to complete expansion (40.4 ± 37.8 days versus 62.5 ± 50.2 days; p < 0.001) and fewer office visits to complete expansion (2.3 ± 1 .7 versus 3.9 ± 1.8; p < 0.001), and were expanded to greater final volumes than subpectoral patients (543.7 ± 122.9 ml versus 477.5 ± 159.6 ml; p = 0.017). Between prepectoral and subpectoral reconstructions, there were similar rates of minor complications (25 percent versus 18.5 percent; p = 0.311), readmissions (5 percent versus 2.4 percent; p = 0.393), seromas (8.3 percent versus 5.6 percent; p = 0.489), reoperations for hematoma (3.3 percent versus 1.6 percent; p = 0.597), and explantations (5 percent versus 2.4 percent; p = 0.393).
This novel analysis demonstrates that prepectoral immediate implant-based breast reconstruction can facilitate expansion to higher total volumes in nearly half the office visits compared to subpectoral placement in similar populations without increasing complication rates.
Therapeutic, III.</abstract><cop>United States</cop><pub>by the American Society of Plastic Surgeons</pub><pmid>31348326</pmid><doi>10.1097/PRS.0000000000005791</doi><tpages>11</tpages></addata></record> |
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| ispartof | Plastic and reconstructive surgery (1963), 2019-08, Vol.144 (2), p.276-286 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Acellular Dermis Breast Implantation - instrumentation Breast Implantation - methods Breast Implants Breast Neoplasms - surgery Female Humans Middle Aged Office Visits - statistics & numerical data Operative Time Postoperative Complications - etiology Reoperation - statistics & numerical data Retrospective Studies Tissue Expansion - instrumentation Tissue Expansion - methods Tissue Expansion Devices |
| title | Reducing Expansion Visits in Immediate Implant-Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement |
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