Direct-to-implant and tissue expander-based immediate breast reconstruction in Chinese women: A comparison of surgical complications and patient-reported outcomes

Background: Direct-to-implant (DTI) breast reconstruction restores patient body image immediately after mastectomy but may increase postoperative complications compared to tissue expander (TE)-based breast reconstruction. Few studies have compared the surgical complications and patient-reported outcomes (PROs) of DTI and TE breast reconstructions in Asian women.

Method: This study compared postoperative complications and PROs between DTI and TE breast reconstruction in Chinese women and explores the risk factors of postoperative complications and the influencing factors of PROs. A retrospective chart review of patients undergoing immediate breast reconstruction between 2008 and 2022 was conducted, and BREAST-Q questionnaires of the breast reconstruction module were distributed to eligible patients. Multivariate regression models were used to explore risk factors for postoperative complications and factors that influence BREAST-Q scores.

Results: DTI was associated with lower rates of major complications and implant loss but had no significant influence on patient satisfaction or quality of life. Age and axillary lymph node dissection were important complication risk factors for both DTI and TE. The application of acellular dermal matrix significantly increased the risk of seroma or hematoma. In the DTI group, capsular contracture significantly reduced patient satisfaction with breast scores.

Conclusion: DTI dual-plane breast reconstruction does not increase complication rates in appropriately selected Chinese patients. In DTI patients, the management of capsular contracture is crucial for improving patient satisfaction.