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Predicting final implant volume in immediate implant based breast reconstruction
Mahsa Bidgoli Moghaddam, MBBS, Steven R. Jacobson, MD, Craig H. Johnson, MD.
Mayo Clinic, Rochester, MN, USA.

BACKGROUND:
Immediate reconstruction has become an established technique for breast reconstruction following mastectomy. A two stage approach remains the preferred method for implant based reconstruction. Historically, the postoperative expansion period takes a minimum of four months to complete, requiring serial expansions until a desired volume is achieved. A one stage operation straight to implant potentially offers improved patient satisfaction while minimizing the downtime associated with the use of tissue expanders. The recovery time is hastened, providing the patient with less interference with activities of daily living.
Limitations of this strategy include the patient’s desire to change breast size, patient selection, an appropriate skin sparing or nipple sparing mastectomy, and technical demands of the procedure. Few studies have looked at what patient variables play a role in predicting final implant volume. Our study aims to identify an association between patient specific variables and final implant volume used during a two stage approach.
METHODS:
A retrospective chart review was completed evaluating all implant based reconstructions over a ten year period. Nine hundred thirty one women with breast implant surgery between January 1999 and December 2009 were studied. We identified 645 patients who had undergone bilateral breast implant surgery. Of these, 163 (25%) were missing information on either pathologic breast weight or implant volume, leaving 482 patients for the analysis.
The associations of age at implant, height, weight, BMI, and pathologic breast weight with implant volume were evaluated using Pearson correlation coefficients. The mean pathologic breast weight and the mean implant volume of the bilateral implants were used in the analysis. All tests were two-sided and p-values <0.05 were considered statistically significant.
RESULTS:
There was a strong positive correlation between patient weight, BMI, and breast weight with requested implant size. Weight was the strongest predictor of implant volume, followed by pathologic breast weight. A model to predict implant volume was developed using multiple linear regression.
CONCLUSIONS:
There is a mathematical relationship between BMI, breast weight and requested implant size in breast reconstruction. The analysis performed in this study provides a guideline for predicting final implant volume based on patient specific variables.


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