Back to 2026 Abstracts
Five-Year Breast Revisions Between Two-Stage Implant, Direct-to-Implant, and Autologous Reconstructions
Andrew Hannoudi
1 Timothy C. Olsen
1, Alan T. Makhoul
1, Aamirah Mccutchen
1, Margaret M. Hornick
1, Ayaka N. Deguchi
1, Robyn B. Broach
1, Joseph Serletti
1, Said Azoury
1
1. Division of Plastic Surgery, University of Pennsylvania, Philadelphia , PA, United States.
Background: Long-term comparative data on revision surgery after postmastectomy reconstruction are limited due to short follow-up periods and frequent grouping of direct-to-implant (DTI) and two-stage implant-based breast reconstruction (IBBR) pathways. A comparison of 5-year revision burden was conducted among immediate two-stage IBBR, autologous breast reconstruction (ABR), and DTI.
Methods: Adults undergoing mastectomy with same-day ABR, DTI, or expander placement followed by implant exchange were identified within a federated EHR network comprising 171 healthcare organizations. Postoperative breast revisions were collected ≥3 months to ≤5 years following breast reconstruction. Multivariable Cox regression identified predictors of revision; significant covariates informed propensity-score matching.
Results: Among 130,439,458 patients, 33,911 received immediate breast reconstruction, of which 11,246 underwent ABR, 12,702 two-stage IBBR, and 9,963 DTI. Obesity, breast malignancy, anxiety, and depression independently increased the hazard of revision (all p<0.001); older age, diabetes, and nicotine dependence were associated with lower hazard (p≤0.044), in each breast reconstruction pathway. After matching, two-stage IBBR exhibited the highest 5-year relative risk of revision (IBBR 32.8% vs. ABR 27.1%; RR 1.21, 95% CI 1.16-1.26) and (IBBR 32.2% vs. DTI 16.3%; RR 1.98, 95% CI 1.88-2.10). ABR demonstrated a higher relative risk than DTI (25.4% vs. 16.0%; RR 1.59, 95% CI 1.50-1.69). Revisions were most frequent during the first postoperative year (two-stage IBBR 21.2%, ABR 18.6%, DTI 9.6%). Higher rates of reduction and augmentation were observed in two-stage IBBR compared to ABR or DTI (all p<0.001).
Conclusion: The 5-year revision burden varies significantly by reconstructive pathway. Two-stage IBBR presents the highest relative risk, ABR offers an intermediate risk, and DTI exhibits the lowest risk. These pathway-specific estimates can enhance counseling by clarifying long-term expectations for TE/implant, ABR, and DTI.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
