title: Comparison of clinical outcomes and patient satisfaction in immediate single-stage versus two-stage implant-based breast reconstruction.
abstract: BACKGROUND
  The purpose of this study was to assess the outcomes of immediate, single-stage, implant-based reconstruction compared with traditional, two-stage reconstruction (i.e., tissue expander placement followed by exchange to implant).
  
  
  METHODS
  A retrospective review of consecutive patients who underwent immediate unilateral or bilateral breast reconstruction over an 8-year period was performed. The primary predictor variable was method of reconstruction (single-stage versus two-stage). Outcome measures were postoperative complication rates, revision rates, and BREAST-Q patient satisfaction scores. Descriptive, bivariate, and multiple regression statistics were computed.
  
  
  RESULTS
  The study sample consisted of 346 subjects who underwent reconstruction of 582 breasts (166 single-stage and 416 two-stage reconstructions). Complication rates between the single-stage and two-stage groups were similar for minor infections, major infections, hematoma formation, seroma formation, minor necrosis, and major necrosis (p ≥ 0.20). In a multiple logistic regression model, subjects undergoing single-stage reconstruction were found to be 87 percent more likely to require revision necessitating an additional operation (p = 0.005). In an adjusted regression model, subjects undergoing two-stage reconstruction had higher BREAST-Q scores for satisfaction with medical and office staff (p ≤ 0.02). Subjects undergoing single-stage reconstruction had higher sexual well-being satisfaction scores.
  
  
  CONCLUSIONS
  There is no significant difference in complication rates between single-stage versus two-stage implant-based breast reconstructions. Although single-stage reconstruction is associated with higher sexual well-being satisfaction, it is more than 80 percent more likely to require additional operative revisions. Two-stage reconstruction is associated with significantly higher satisfaction with the medical and office staff.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Baltimore, Md.; and Boston, Mass. From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Maryland Medical Center; the Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital; and Longwood Plastic Surgery.
authors.forename: Srinivas M
authors.initials: SM
authors.lastname: Susarla
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ganske
authors.forename: Lydia
authors.initials: L
authors.lastname: Helliwell
authors.forename: Donald
authors.initials: D
authors.lastname: Morris
authors.forename: Elof
authors.initials: E
authors.lastname: Eriksson
authors.forename: Yoon S
authors.initials: YS
authors.lastname: Chun
mesh_terms: D019928:Breast Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome