title: Outcome analysis of expander/implant versus microsurgical abdominal flap breast reconstruction: a critical study of 254 cases.
abstract: BACKGROUND
  Expander-implant breast reconstruction (EIBR) and microsurgical abdominal flap breast reconstruction (MAFBR) are currently the two most frequent breast reconstruction techniques performed in the United States. The aim of this study was to compare outcomes between EIBR and MAFBR in order to help future breast cancer patients to be more knowledgeable and better informed in choosing their optimal reconstruction option.
  
  
  METHODS
  Medical records of 795 patients who underwent breast reconstruction at Stanford Hospital from 2007 to 2011 were reviewed. We found 254 patients to be candidates for both MAFBR and EIBR preoperatively and included them in the study. Patients demographics, postoperative clinic visits, length of hospital stay, postoperative complications, and follow-up time were compared. Logistic regression analysis was used to determine risk factors for major complications.
  
  
  RESULTS
  MAFBR patients had 8.7 clinic visits postoperatively, while 14.6 visits were needed for EIBR patients. Length of hospital stay was 4.8 ± 1.32 days for MAFBR and 2.1 ± 0.9 days for EIBR. Complication occurred in 21.3 % of MAFBR versus 37.4 % for EIBR patients. Follow-up duration was 24.7 ± 17.2 months for EIBR and 30.1 ± 18.5 months for MAFBR. On multivariate analysis, EIBR and a body mass index of ≥30 kg/m(2) were the only significant predictors of major complication.
  
  
  CONCLUSIONS
  For patients eligible for both options, MAFBR has a lower incidence of major complications and fewer postoperative visits, but it has a longer initial hospital stay compared to EIBR. Patients should be informed of not only short-term but also long-term possible risks and benefits in order to make an informed decision.
authors.affiliation: Peking Union Medical College, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Palo Alto, CA, USA.
authors.forename: Chunjun
authors.initials: C
authors.lastname: Liu
authors.forename: Arash
authors.initials: A
authors.lastname: Momeni
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhuang
authors.forename: Jie
authors.initials: J
authors.lastname: Luan
authors.forename: Michael T
authors.initials: MT
authors.lastname: Chung
authors.forename: Eric
authors.initials: E
authors.lastname: Wright
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D000328:Adult; D015992:Body Mass Index; D019928:Breast Implantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009819:Office Visits / Q000706:statistics & numerical data; D011475:Prosthesis Failure / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000209:etiology; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D013524:Surgical Flaps / Q000009:adverse effects* / Q000473:pathology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D015626:Tissue Expansion / Q000009:adverse effects*