Nima Khavanin1,2, Mark W Clemens1,2, Andrea L Pusic1,2, Neil A Fine1,2, Jennifer B Hamill1,2, H Myra Kim1,2, Ji Qi1,2, Edwin G Wilkins1,2, John Y S Kim1,2. 1. Baltimore, Md.; Houston, Texas; New York, N.Y.; Chicago, Ill.; and Ann Arbor, Mich. 2. From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine; and the Section of Plastic Surgery and the Department of Biostatistics, University of Michigan.
Abstract
BACKGROUND: Since the 2012 approval of shaped implants, their use in breast reconstruction has increased in the United States. However, large-scale comparisons of complications and patient-reported outcomes are lacking. The authors endeavored to compare surgical and patient-reported outcomes across implant types. METHODS: The Mastectomy Reconstruction Outcomes Consortium database was queried for expander/implant reconstructions with at least 1-year postexchange follow-up (mean, 18.5 months). Outcomes of interest included postoperative complications, 1-year revisions, and patient-reported outcomes. Bivariate and mixed-effects regression analyses evaluated the effect of implant type on patient outcomes. RESULTS: Overall, 822 patients (73.5 percent) received round and 297 patients (26.5 percent) received shaped implants. Patients undergoing unilateral reconstructions with round implants underwent more contralateral symmetry procedures, including augmentations (round, 18.7 percent; shaped, 6.8 percent; p = 0.003) and reductions (round, 32.2 percent; shaped, 20.5 percent; p = 0.019). Shaped implants were associated with higher rates of infection (shaped, 6.1 percent; round, 2.3 percent; p = 0.002), that remained significant after multivariable adjustment. Other complication rates did not differ significantly between cohorts. Round and shaped implants experienced similar 2-year patient-reported outcome scores. CONCLUSIONS: This prospective, multicenter study is the largest evaluating outcomes of shaped versus round implants in breast reconstruction. Although recipients of round implants demonstrated lower infection rates compared with shaped implants, these patients were more likely to undergo contralateral symmetry procedures. Both implant types yielded comparable patient-reported outcome scores. With appropriate patient selection, both shaped and round implants can provide acceptable outcomes in breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
BACKGROUND: Since the 2012 approval of shaped implants, their use in breast reconstruction has increased in the United States. However, large-scale comparisons of complications and patient-reported outcomes are lacking. The authors endeavored to compare surgical and patient-reported outcomes across implant types. METHODS: The Mastectomy Reconstruction Outcomes Consortium database was queried for expander/implant reconstructions with at least 1-year postexchange follow-up (mean, 18.5 months). Outcomes of interest included postoperative complications, 1-year revisions, and patient-reported outcomes. Bivariate and mixed-effects regression analyses evaluated the effect of implant type on patient outcomes. RESULTS: Overall, 822 patients (73.5 percent) received round and 297 patients (26.5 percent) received shaped implants. Patients undergoing unilateral reconstructions with round implants underwent more contralateral symmetry procedures, including augmentations (round, 18.7 percent; shaped, 6.8 percent; p = 0.003) and reductions (round, 32.2 percent; shaped, 20.5 percent; p = 0.019). Shaped implants were associated with higher rates of infection (shaped, 6.1 percent; round, 2.3 percent; p = 0.002), that remained significant after multivariable adjustment. Other complication rates did not differ significantly between cohorts. Round and shaped implants experienced similar 2-year patient-reported outcome scores. CONCLUSIONS: This prospective, multicenter study is the largest evaluating outcomes of shaped versus round implants in breast reconstruction. Although recipients of round implants demonstrated lower infection rates compared with shaped implants, these patients were more likely to undergo contralateral symmetry procedures. Both implant types yielded comparable patient-reported outcome scores. With appropriate patient selection, both shaped and round implants can provide acceptable outcomes in breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Authors: David Chopp; Vinay Rawlani; Marco Ellis; Sarah A Johnson; Donald W Buck; Seema Khan; Kevin Bethke; Nora Hansen; John Ys Kim Journal: Can J Plast Surg Date: 2011
Authors: W Grant Stevens; Jennifer Harrington; Kaveh Alizadeh; Lewis Berger; David Broadway; T Roderick Hester; Donald Kress; Rosalyn d'Incelli; JoAnn Kuhne; Maggi Beckstrand Journal: Plast Reconstr Surg Date: 2012-11 Impact factor: 4.730
Authors: M A Sprangers; M Groenvold; J I Arraras; J Franklin; A te Velde; M Muller; L Franzini; A Williams; H C de Haes; P Hopwood; A Cull; N K Aaronson Journal: J Clin Oncol Date: 1996-10 Impact factor: 44.544
Authors: Antonio Carlos Abramo; Valeria Ribeiro De Oliveira; Miguel Cirilo Ledo-Silva; Erick Leonardo De Oliveira Journal: Aesthetic Plast Surg Date: 2010-03-31 Impact factor: 2.326
Authors: W Grant Stevens; Maurice Y Nahabedian; M Bradley Calobrace; Jennifer L Harrington; Peter J Capizzi; Robert Cohen; Rosalyn C d'Incelli; Maggi Beckstrand Journal: Plast Reconstr Surg Date: 2013-11 Impact factor: 4.730
Authors: W Grant Stevens; Jennifer Harrington; Kaveh Alizadeh; David Broadway; Kamakshi Zeidler; Tess B Godinez Journal: Aesthet Surg J Date: 2015-05 Impact factor: 4.283
Authors: Joshua Vorstenbosch; Colleen M McCarthy; Meghana G Shamsunder; Thais O Polanco; Stefan Dabic; Itay Wiser; Evan Matros; Joseph Dayan; Joseph J Disa; Andrea L Pusic; Michele R Cavalli; Elizabeth Encarnacion; Meghan Lee; Babak J Mehrara; Jonas A Nelson Journal: Plast Reconstr Surg Date: 2021-11-01 Impact factor: 5.169
Authors: Berry Fairchild; Warren Ellsworth; Jesse C Selber; David P Bogue; Dmitry Zavlin; Stephanie Nemir; Cristina M Checka; Mark W Clemens Journal: Aesthet Surg J Date: 2020-01-01 Impact factor: 4.283
Authors: Stacey J Jones; Philip Turton; Rajgopal Achuthan; Brian V Hogan; Shireen N Mckenzie; Baek Kim Journal: Plast Reconstr Surg Glob Open Date: 2020-12-17