Two-stage Implant-based Breast Reconstruction Without the Use of Tissue Expanders

Abstract

Background: The use of a tissue expander (TE) followed by a definitive implant is the most common approach for breast reconstruction after mastectomy. The purpose of this study was to determine if a first-stage, low-projection definitive silicone implant could replace the use of a TE.

Methods: Between January 2016 and January 2024, 155 consecutive high-risk patients with breast cancer underwent breast reconstruction with a first-stage definitive implant after mastectomy in the implant-only (IO) group. All IO patients underwent a subsequent second-stage implant exchange to get to their goal reconstruction size. Outcomes were compared with a similar high-risk population who underwent conventional 2-stage reconstruction with a first-stage TE.

Results: The risk of all complications, including reconstructive failure, was similar between the groups, except for an increased risk of minor postoperative wounds in the IO group and a higher risk of seroma requiring operative drainage in the TE group.

Conclusions: The success rate of 2-stage breast reconstruction in high-risk patients after mastectomy is similar using either a first-stage TE or low-projection definitive implant. Two-stage reconstruction using the IO approach offers patients the opportunity to reduce the cost, discomfort, inconvenience, and complications associated with repeated TE fills. It also allows them to pursue their second-stage reconstruction at their convenience when compared with patients with TEs who are encouraged to undergo exchange in a timely fashion.

Fig. 1.

A 53-year-old woman with multicentric right breast cancer and a history of bilateral subpectoral breast augmentation with 520 mL implants who presented for bilateral mastectomy and reconstruction.

Fig. 2.

The patient from Figure 1, 5 weeks postoperative from bilateral mastectomy and reconstruction with Allergan smooth, responsive, low-projection 410 mL silicone implants.

Fig. 3.

The patient from Figure 2 is shown 3 weeks status post exchange of her low-projection silicone implants for Allergan smooth, cohesive, extra-high-projection 750 mL silicone implants.

Fig. 4.

The patient from Figure 3 is shown 10 months after the completion of radiotherapy with acceptable asymmetry between the breasts.

Fig. 5.

A 52-year-old morbidly obese woman with a BMI of 43 kg/m², diabetes, and left breast cancer who desired bilateral mastectomy and implant reconstruction with augmentation of her breast size.

Fig. 6.

The patient from Figure 5 is shown 1 year after bilateral mastectomy and reconstruction with Allergan smooth, responsive, low-projection 460 mL silicone implants. She has not scheduled a second surgery, now 4 years after her initial surgery.