A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part II. An analysis of long-term complications, aesthetic outcomes, and patient satisfaction.
BACKGROUND
Few reports have critically evaluated long-term outcomes following two-stage implant reconstruction. The objective of this study was to evaluate long-term aesthetic results, late complications, and patient satisfaction following tissue expander/implant breast reconstruction. A single surgeon's extensive experience with implant-based reconstruction provides an opportunity to evaluate these results in a uniformly treated patient population.


METHODS
A total of 1522 tissue expander/implant reconstructions were initiated in 1221 patients from July of 1992 to June of 2004. Data on a cohort of 315 patients (410 reconstructions) with a minimum of 1 year of follow-up were entered into a prospectively maintained outcomes database. Overall aesthetic grade, capsular contracture grade, patient satisfaction, and late complications were prospectively evaluated, and outcome data were recorded on an ongoing basis.


RESULTS
Mean follow-up was 36.7 months. Eighty-eight percent of patients had a good to excellent aesthetic result. Laterality of reconstruction (bilateral versus unilateral) and radiation history were significant predictors of overall cosmesis. Aesthetic results were not related to preoperative breast size, implant volume, or body mass index. Pathologic capsular contractures (grade III/IV) developed in 10.4 percent of patients. Four percent of all permanent implants were exchanged for a second prosthesis. Ninety-five percent of patients were satisfied with their reconstruction.


CONCLUSIONS
Tissue expander/implant reconstruction yields good to excellent long-term aesthetic results in the majority of patients, and overall patient satisfaction remains high. Bilateral reconstructions have higher overall aesthetic grades. Reconstruction may be performed in patients with larger-volume breasts with satisfactory cosmesis. Successful outcomes are possible in patients who receive chest wall irradiation.
Cordeiro
Peter G
PG
New York, N.Y. From the Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.
McCarthy
Colleen M
CM
D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods; D018427:Breast Implants; D003131:Combined Modality Therapy; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D015625:Tissue Expansion Devices; D016896:Treatment Outcome