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Comparing 6 Month Postoperative Outcomes of Direct to Implant vs. Delayed Implant Based Reconstruction in 25,782 Patients
Abby Chopoorian Fuchsman
*, Amit Singal, Kate Manley, Sophia Salingaros, Samuel Medina, Matthew W. Liao, Xue Dong, Jason A. Spector
Weill Cornell Medicine, New York, NY
Background: Breast reconstruction after mastectomy can be implant based or autologous. Implant based is most common and performed in one (direct to implant [DTI]) or two stages (delayed). There are concerns over complication rates for DTI without strong evidence. This study compares 6-month postoperative outcomes between DTI and delayed implant breast reconstruction in a retrospective multi-center study.
Methods: Using TriNetX, a federated electronic medical record network containing ~150 million patients from 105 healthcare organizations, we compared 6-month postoperative outcomes between DTI (CPT 19340) and delayed (CPT 19342 without previous 19328 or 19330) implant breast reconstruction. Cohorts were limited to females between the ages of 18-99 and propensity score matched for age, race, ethnicity, diabetes, and obesity. Results are reported as odds ratio with 95% confidence intervals.
Results: Propensity score matching yielded 12,891 patients in each cohort. 6 months postoperatively, DTI had significantly higher likelihood of removal of ruptured implant (2.538 [1.395, 4.616]), removal of intact implant (2.443 [2.093, 2.852]), revision of peri-implant capsule (1.533 [1.240, 1.896]), complete capsulectomy (1.525 [1.272, 1.829]), hematoma or seroma (1.937 [1.650, 2.275]), fat necrosis of breast (2.158 [1.644, 2.831]), necrosis (4.253 [2.891, 6.257]), post-operative infection (1.742 [1.458, 2.082]), infection or inflammation attributed to implant (1.722 [1.473, 2.014]), mechanical complication of the implant (1.367 [1.242, 1.504]), and revision of reconstructed breast (1.237 [1.121, 1.366]) compared to the delayed cohort. There was no difference in likelihood capsular contracture (1.077 [0.936, 1.240]) between groups.
Conclusions: DTI has higher likelihood of implant removal, capsule revision, complete capsulectomy, hematoma or seroma, fat necrosis, necrosis, postoperative infection, infection or inflammation due to implant, mechanical complication of implant, and revision of reconstructed breast compared to delayed reconstruction 6 months postoperatively.
ICD 10 and CPT codes of outcomes
| Outcome | ICD 10 | CPT |
| Removal of ruptured implant | | 19330 |
| Removal of intact implant | | 19328 |
| Revision of peri-implant capsule | | 19370 |
| Complete capsulectomy | | 19371 |
| Hematoma or seroma | M96.84, L76.3 | 10140 |
| Fat necrosis | N64.1 | |
| Necrosis | I96 | |
| Infection | T81.4 | |
| Infection/inflammation due to implant | T85.7 | |
| Mechanical complication of implant | T85.4 | |
| Capsular contracture | T85.44 | |
| Revision of reconstructed breast | | 19380 |
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