World journal of surgery · 2026
Direct-to-Implant Versus Two-Stage Tissue Expander/Implant Reconstruction: A Decade of Institutional Experience From China.
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Su Cong, Wang Shu, He Shanshan, Zhao Weiqing, Yin Jian
Аннотация
BACKGROUND: The choice between direct-to-implant (DTI) and two-stage tissue expander/implant (TE/I) breast reconstruction remains debated. This study aimed to compare complication profiles between these techniques and evaluate the modifying effect of postoperative radiotherapy in a large Asian cohort.
METHODS: A retrospective single-center analysis was performed on patients who underwent immediate prosthetic breast reconstruction from 2014 to 2023. Patients were grouped by DTI or TE/I. Propensity score full matching was used to balance baseline covariates. Subgroup analysis by postoperative radiotherapy status was conducted.
RESULTS: 569 female patients (600 breasts) were included. 437 patients (465 breasts) underwent DTI and 132 patients (135 breasts) underwent TE/I breast reconstruction. After full matching on the propensity score, the TE group had significantly higher risks of any complication (p = 0.002), reconstructive failure (p < 0.001), implant or expander removal (p < 0.001), and exposure of implant or expander (p < 0.001) compared with the DTI group. In the subgroup analysis, TE/I had higher risks of failure, removal, and exposure in the non-radiotherapy subgroup, whereas in the radiotherapy subgroup most complications showed no intergroup differences, and TE/I had a significantly lower risk of flap necrosis (p = 0.002).
CONCLUSIONS: TE group had higher complication rates than DTI group, but postoperative radiotherapy significantly modifies the risk profile. In irradiated patients, TE may offer a protective effect against flap necrosis. These findings provide evidence-based guidance for individualized surgical decision-making in Asian populations.
METHODS: A retrospective single-center analysis was performed on patients who underwent immediate prosthetic breast reconstruction from 2014 to 2023. Patients were grouped by DTI or TE/I. Propensity score full matching was used to balance baseline covariates. Subgroup analysis by postoperative radiotherapy status was conducted.
RESULTS: 569 female patients (600 breasts) were included. 437 patients (465 breasts) underwent DTI and 132 patients (135 breasts) underwent TE/I breast reconstruction. After full matching on the propensity score, the TE group had significantly higher risks of any complication (p = 0.002), reconstructive failure (p < 0.001), implant or expander removal (p < 0.001), and exposure of implant or expander (p < 0.001) compared with the DTI group. In the subgroup analysis, TE/I had higher risks of failure, removal, and exposure in the non-radiotherapy subgroup, whereas in the radiotherapy subgroup most complications showed no intergroup differences, and TE/I had a significantly lower risk of flap necrosis (p = 0.002).
CONCLUSIONS: TE group had higher complication rates than DTI group, but postoperative radiotherapy significantly modifies the risk profile. In irradiated patients, TE may offer a protective effect against flap necrosis. These findings provide evidence-based guidance for individualized surgical decision-making in Asian populations.