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Trends in Ancillary Procedures Following Staged Implant-based Breast Reconstruction
Annie B. McVeigh
*, Zachary Zamore, Matthew J. Heron, Carisa Cooney, Kristen P. Broderick
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Background: The growing popularity of prepectoral breast reconstruction has contributed to anecdotal shifts in practice patterns around ancillary procedures to optimize aesthetic outcomes, such as nipple areola complex (NAC) reconstruction and autologous fat grafting. This study aims to examine trends in supplemental procedures following staged implant-based reconstruction.
Methods: We conducted a retrospective review using the TriNetX database of de-identified patient data. Using CPT codes, we identified adult female patients who underwent (1) mastectomy, (2) tissue expander (TE) placement between 2013 and 2020, and (3) implant exchange. Patients were grouped by year of TE placement and procedure-related characteristics were collected.
Results: We identified 9,870 patients who underwent TE placement between 2013 and 2020 and subsequent implant exchange. There were 804 patients in the 2013 cohort compared to 1,560 in the 2020 cohort. The use of fat grafting was observed to increase during this period. Fat grafting was 2.77-fold more prevalent in the 2020 cohort compared to the 2013 cohort (95% CI, 2.34-3.28). Notably, the percentage of patients undergoing more than one round of fat grafting increased from 3.9% in the 2013 cohort to 11.9% in the 2020 cohort (p<0.0001). Fat grafting at the time of implant exchange was also more common in later cohorts, increasing from 6.6% of patients in the 2013 cohort to 32.8% in the 2020 cohort (p<0.0001). Over the study period, rates of NAC reconstruction were observed to decrease. 9.7% of patients in the 2020 cohort underwent NAC reconstruction compared to 25.0% in the 2013 cohort (p<0.0001). Nipple tattooing procedures were also performed less frequently in recent cohorts.
Conclusion: We suspect that fat grafting has become more common for its ability to correct for contour irregularities and rippling that may be seen with prepectoral reconstruction. By contrast, we hypothesize that rates of NAC reconstruction have fallen given thinner skin flaps over prepectoral implants and increasing adoption of nipple-sparing mastectomies.
Figure 1: Ancillary Reconstruction Procedures, 2010 - 2024
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