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BACKGROUND: Optimal reconstruction techniques for NSM continue to be established; we thus aim to compare outcomes with permanent implant and tissue expander (TE)-based reconstruction.
METHODS: All patients undergoing NSM were reviewed and outcomes were compared between those who underwent permanent implant and TE-based reconstruction.
RESULTS: Of 842 NSMs, 160 and 447 underwent reconstruction with immediate, permanent implants and TEs, respectively. Age (p=0.8988), mastectomy indication (p=0.0991), and BMI (p=0.4313) were similar, however permanent implant reconstruction patients were significantly less likely to be current or former smokers (p=0.0176). They were more likely to have lateral inframammary fold and less likely to have lateral radial mastectomy incisions (p<0.0001). Permanent implant size was significantly greater compared to initial TE fill volumes (p<0.0001); permanent implant reconstruction patients had significantly more acellular dermal matrix coverage (p<0.0001). Permanent implant reconstruction patients had significantly fewer operative reconstructive procedures (p<0.0001) and shorter follow-up times (p<0.0001). Permanent implant reconstruction patients had significantly more full (p=0.0052) and partial thickness (p=0.0042) nipple-areola complex necrosis, explantation (p=0.0052), and minor mastectomy flap necrosis (p<0.0001) while TE-based reconstruction patients had significantly more cellulitis requiring oral antibiotics (p=0.0076). Other complications were similar between the groups.
CONCLUSIONS: Immediate, permanent implant-based reconstruction in NSM provides a breast with fewer operative procedures but greater rates of NAC necrosis, explantation, and mastectomy flap necrosis compared to TE-based reconstruction. This technique may still provide excellent results in appropriately selected patients.