title: Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: predictors of failure.
abstract: BACKGROUND
  Direct-to-implant single-stage immediate breast reconstruction using acellular dermal matrix is a cost-effective alternative to two-stage expander-implant reconstruction. The purpose of this study was to identify predictors of direct-to-implant single-stage immediate breast reconstruction failure, defined as need for early (≤6 months) revision surgery.
  
  
  METHODS
  The authors conducted a retrospective cohort study of all patients with direct-to-implant single-stage immediate breast reconstruction in 2010 and 2011 at three University of British Columbia hospitals. Data were compared between successful and failed single-stage reconstructions. Predictors of failure were identified using multivariate logistic regression. Patient demographics and complications were compared to a random sample of control patients with two-stage alloplastic reconstruction without acellular dermal matrix.
  
  
  RESULTS
  Of 164 breasts that underwent direct-to-implant single-stage immediate breast reconstruction, 52 (31.7 percent) required early revision. Increasing breast cup size was the only significant predictor of early revision compared with bra size A (OR for bra size B, 4.86; C, 4.96; D, 6.01; p < 0.05). Prophylactic mastectomies showed a trend toward successful single stage (OR, 0.47; p = 0.061), whereas smoking history trended toward failure (OR, 1.79; p = 0.065). Mastectomy flap necrosis was significantly higher in direct-to-implant single-stage immediate reconstruction cases compared to two-stage controls.
  
  
  CONCLUSIONS
  Direct-to-implant breast reconstruction can be reliably performed in a single stage in patients with small breast size. Increasing breast cup size confers a higher chance of early revision. A two-stage approach may be more cost-effective in larger breasted patients.
  
  
  METHODS
  Risk, III.
authors.affiliation: Vancouver, British Columbia, Canada From the Division of Plastic and Reconstructive Surgery, University of British Columbia.
authors.forename: Perry
authors.initials: P
authors.lastname: Gdalevitch
authors.forename: Adelyn
authors.initials: A
authors.lastname: Ho
authors.forename: Krista
authors.initials: K
authors.lastname: Genoway
authors.forename: Hasmik
authors.initials: H
authors.lastname: Alvrtsyan
authors.forename: Esta
authors.initials: E
authors.lastname: Bovill
authors.forename: Peter
authors.initials: P
authors.lastname: Lennox
authors.forename: Nancy
authors.initials: N
authors.lastname: Van Laeken
authors.forename: Sheina
authors.initials: S
authors.lastname: Macadam
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D057910:Implant Capsular Contracture / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure