Staging.

There are three main forms of immediate breast reconstruction after mastectomy: autologous, direct-to-implant (DTI), and staged tissue expander then implant (TE/I). In this large retrospective study from Mass Gen, nearly 1300 patients had over 1800 breast reconstructions after mastectomy. Autologous reconstruction was done in 24%, DTI in 32%, and TE/I in 43%. First, TE/I technique was associated with higher complication rates than both the DTI and autologous techniques—including infection, rupture, contracture, and implant failure. Second, post-mastectomy radiation (PMRT) was given in 41% of patients—who, by the way, were more likely to have nodal dissections and chemo—and it increased complication rates across groups: 11 → 15% for autologous, 13→ 18% for DTI, and 19 → 37% for TE/I. Over two-thirds of the TE/I complications occurred after exchange of the expander for implant, while delayed autologous reconstruction had roughly half the rate of complications as immediate autologous reconstruction. TBL: A single-stage implant-based reconstruction is associated with lower complication rates than staged reconstruction, but immediate autologous reconstruction has double the complication rate of delayed autologous reconstruction. | Naoum, Int J Radiat Oncol Biol Phys 2019