A Retrospective Study Of The Postoperative Effects And Clinical Outcomes Of One-stage Immediate And Two-stage Breast Reconstructio

PurposeThe purpose of this study includes:1)To establish a database of patients undergoing Direct-to-Implant(DTI)and immediate two-stage(TE)breast reconstruction in the Department of Plastic and Cosmetic Surgery of Peking Union Medical College Hospital from 2008 to 2022;2)To compare the differences in postoperative complications,patient-reported outcomes,and oncological outcomes between DTI and TE;3)To explore the factors influencing the complications,patient-reported outcomes,and oncological outcomes of immediate breast reconstruction.MethodThis study employs retrospective and survey research methods.Firstly,the database of patients undergoing immediate DTI and immediate two-stage breast reconstruction in the Department of Plastic and Cosmetic Surgery of Peking Union Medical College Hospital between 2008 and 2022 was established.Then patients who met the inclusion and exclusion criteria were contacted and surveyed.The survey results were analyzed to determine the differences in complication rates,patient-reported outcomes,and oncological outcomes between DTI and TE.And the factors influencing the complications,patient-reported outcomes,and tumor outcomes of immediate breast reconstruction surgery were analyzed.The content of the follow-up survey mainly includes outcome variables,influencing factors,and control variables.The main outcome variable of the study is the occurrence of complications,and the secondary outcome variables are patient-reported outcomes and tumor recurrence and metastasis.In this study,qualified patients were interviewed by telephone according to the contact information left in the medical records,questionnaires were distributed,filled,recovered,and managed by WJX,and data analysis was carried out by SPSS 26.0 software.ResultA total of 139 responders were included in the study,of whom 94 patients underwent Direct-to-Implant(DTI)reconstruction and 45 patients underwent immediate two-stage breast reconstruction.The incidence of major complications and the proportion of reconstruction failure in the TE group were significantly higher than those in the DTI group.There were no significant differences in the incidence of seroma,hematoma,flap necrosis,Nipple-Areolar-Complex(NAC)necrosis,wound dehiscence,and capsular contracture between the DTI and TE groups.Binary logistic regression analysis of complications found that DTI or TE had no significant effect on the occurrence of all complications.Age>40 years and hypertension were risk factors for seroma.Age>40 years was a risk factor for NAC necrosis.Age>40 years was a risk factor for capsular contracture.BMI>24kg/m2 and ADM application were protective factors for capsular contracture.Age>40 years and modified radical mastectomy were risk factors for overall complications.There were no significant differences in Breast-Q psychosocial well-being,sexual well-being,physical well-being of the chest,and satisfaction with breasts between DTI and TE breast reconstruction.There was no significant difference in tumor recurrence and metastasis between DTI and TE breast reconstruction.ConclusionDTI did not increase surgical complications and tumor recurrence and metastasis,and the patient-reported outcomes were comparable to immediate two-stage breast reconstruction.The risk of flap necrosis was greater in older patients,patients with higher BMI,and patients who underwent modified radical mastectomy.Older age and modified radical mastectomy were also risk factors for overall complications.The application of ADM could significantly reduce the incidence of capsular contracture without increasing the incidence of other complications.Older age and hypertension were risk factors for seroma,and older patients were also more likely to develop NAC necrosis.