National trends in revision procedures in post-mastectomy breast reconstruction: Autologous vs implant-based approaches

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 95; pp. 127 - 133
• Main Authors: Francis, Shannon D., Kang, Augustine W., Maheta, Bhagvat J., Sangalang, Brian R., Salingaros, Sophia, Wu, Robin T., Nazerali, Rahim S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-08-2024
• Subjects: Adult; Autologous breast reconstruction; Breast Implantation - methods; Breast Implantation - statistics & numerical data; Breast Implantation - trends; Breast Implants; Breast Neoplasms - surgery; Breast reconstruction; Female; Humans; Implant breast reconstruction; Mammaplasty - methods; Mammaplasty - statistics & numerical data; Mammaplasty - trends; Mastectomy; Middle Aged; Reoperation - statistics & numerical data; Retrospective Studies; Revision; Tissue expander; Transplantation, Autologous - statistics & numerical data; United States; United States; Tissue expander; Revision; Autologous breast reconstruction; Breast reconstruction; Implant breast reconstruction
• ISSN: 1748-6815; 1878-0539; 1878-0539
• DOI: 10.1016/j.bjps.2024.05.048

Breast reconstruction involves collaborative decision-making between patients and surgeons, but the need for multiple revisions after the initial reconstructive surgery process can burden patients and the healthcare system. This study explored how the type of breast reconstruction (autologous [ABR], immediate implant-based reconstruction [IBR], or two-stage IBR) impacts postreconstruction revision rates.
Using MarketScan Databases, a retrospective database study (2007–2021) was conducted, identifying revision procedures through Current Procedural Terminology codes. Statistical analysis with linear models, adjusted for patient characteristics and surgical factors, used a significance threshold of p < 0.05.
Among 58,264 patients, 6.2% of ABR patients, 3.8% of immediate IBR patients, and 3.6% of two-stage IBR patients underwent future revisions. IBR had a 51% lower incidence rate of revision operations than ABR (incidence rate ratio = 0.49, p < 0.001). Within IBR, there was no significant difference in the number of operations between immediate IBR (0.06 ± 0.32) and two-stage IBR (0.05 ± 0.32, p = 0.95). Immediate IBR demonstrated 12% (OR = 0.88, p = 0.0022) and 70% (OR = 0.30, p < 0.001) lower odds of requiring breast revision and fat grafting compared to ABR, respectively. Two-stage reconstruction had 66 % lower odds of requiring only fat grafting than ABR (OR = 0.34, p < 0.001).
ABR necessitated a higher number of total revision procedures after completion of the initial reconstruction. These findings will better equip providers and patients to counsel patients in understanding their reconstructive journey, planning their reconstructions and timing, and provide more accurate estimates of the number of procedures that will be required to reach their aesthetic goals and final outcome.