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Does Size Matter? Evaluating the Impact of Resection Weight and Implant Volume Discrepancies on Breast Reconstruction Outcomes
Jie Jung Shih
1, Christian Lava
1, Karen Li
1, Kana Behari
1, Claire Holmvik
1, Nichole Andrade
1, Rachel Rohrich
1, Kenneth Fan
2
1Georgetown University School of Medicine, USA; 2Medstar Georgetown University Hospital, USA
Background: The choice of implant volume following oncologic breast reconstruction involves shared physician-patient decision making and careful consideration of the patient's goals. Several studies have shown that a higher mastectomy weight and larger initial implant volumes are associated with an increased risk of complications. However, there is limited literature on how discrepancies in weight and volume affect outcomes. This study evaluates the impact of discrepancy ratios on postoperative outcomes in patients undergoing immediate implant-based breast reconstruction (IBBR).
Methods: A multicenter retrospective review of IBBR patients undergoing immediate, acellular dermal matrix (ADM)-assisted IBBR from January 2014 and July 2022 was conducted. Patient characteristics, operative details, and complications (minor [e.g., seroma, infection]; major [i.e., requiring return to the operating room]) were collected. The discrepancy ratio was calculated by (mastectomy tissue weight [g] - implant volume [mL]) divided by mastectomy tissue weight (g).
Results: A total of 504 patients (882 breasts) underwent IBBR. Mean age was 49.47±11.48. Median CCI was 2 (IQR: 1). Mean amount of tissue resected per breast was 504.49±340.83 (range=40-3,720) g. Mean implant volume was 462.73±136.66 (range=100-850) mL. 64 (7.3%), 311 (35.3%), 297 (33.7%), 119 (13.5%), 91 (10.3%) had a discrepancy ratio of +50 to +100%, 0 to +49%, 0 to -49%, -50 to -99% and greater than -100% respectively. Collectively, the +50 to +100% group had the highest rate of minor complications at 59.38% (p<0.001), including seroma at 15.6% (p=0.015), flap necrosis at 18.8% (p<0.001), and infection at 10.9% (p=0.033). The incidence of reoperation between groups was 26.6%, 18.3%, 14.8%, 16.0%, and 14.3% for +50 to +100%, 0 to +49%, 0 to -49%, and -50 to -99% cohorts, respectively (p=0.138).
Conclusion: A discrepancy ratio, particularly those exceeding 50%, was associated with increased minor complications, emphasizing the need for shared physician-patient decision making to optimize outcomes.
Implant Volume and Mastectomy Weight Respective. Top is Minor Surgical Complications and Categories and Bottom is Major Reconstructive Failure
Discrepancies and Respective Complications. Top is Minor Surgical Complications and Categories and Bottom is Major Reconstructive Failure
Mastectomy Weight Implant Volume Difference over Mastectomy Weight Ratio and Post Surgical Complication Rates, with Total Number of Samples and Complications Reported. Top is Minor Surgical Complications and Categories and Bottom is Major Reconstructive Failure
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