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Evaluation of the Total Number of Outpatient Follow-up Visits after Implant-Based versus Autologous Breast Reconstruction over 10 years
Lauriane Pinto
1, Michael Mazarei
1, Anna E. Bazell
1, Alexa Rivera del Rio Hernandez
1, Sriram Zassenhaus
1, Carolyn De La Cruz
1
1. Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Background: Breast reconstruction pathways differ markedly in the intensity and duration of postoperative care, yet the long-term outpatient burden for each technique is poorly defined. We quantified the 10-year cumulative follow-up of tissue expansion, revision procedures and complications across direct-to-implant (DTI), tissue-expander to implant (TE→implant), autologous (DIEP/TRAM), and latissimus flap plus TE/implant (LD-TE) reconstructions.
Methods: We performed a single surgeon retrospective review of breast cancer patients undergoing reconstruction (2006-2015) with minimum ≥10 years follow-up. Our primary outcome was the cumulative number of postoperative plastic-surgery outpatient visits. Secondary outcomes included complications, and revision procedures. Group differences by reconstructive type were analyzed using t-tests and chi-square tests.
Results: A total of 870 patients were reviewed; 610 met inclusion (autologous n=160, TE→implant n=330, direct-to-implant n=12, LD-TE n=108). Total visit counts differed significantly by reconstruction type, with autologous showing the lowest overall burden (median autologous = 16, median TE → implant = 21, median LD-TE = 22, median DTI = 11; p < 0.001). Complications were associated with increased visits, most notably for autologous (19.77 with complications vs 13.64 without; Δ=+6.13) compared with TE → implant (23.44 vs 19.51; Δ=+3.93) and LD-TE (24.43 vs 19.20; Δ=+5.23). Mean number of visits within the first postoperative year were: autologous 7.8, TE → implant 12.3, LD-TE 11.9, direct-to-implant 4.1. Between years 3-10, rates were 0.78, 2.72, 2.30, and 1.18 per year (autologous, TE → implant, LD-TE, and direct-to-implant respectively.
Discussion: Autologous reconstruction was associated with a lower demand of outpatient use than TE-based approaches. However, complications more strongly impacted number of encounters for autologous reconstruction. Patients deserve counseling not only about the operation, but the decade-long care journey that follows"”so they can choose the option that best fits their lives.
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