Immediate implant replacement provides new option for reconstruction after mastectomy

In selected cases, immediate reconstruction provides good results with low complication rate

April 11, 2011
American Society of Plastic Surgeons (ASPS)

Immediate breast reconstruction using implants provides a new alternative for many women undergoing mastectomy for breast cancer, suggests a study in the April issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Although it's not appropriate for all women, immediate breast implant placement provides "very good aesthetic results" with a low complication rate, according to the report by ASPS Member Surgeon Christopher A. Crisera, M.D., and colleagues at University of California Los Angeles. Immediate implant placement may also help lessen psychological distress, while reducing the need for multiple surgical procedures and associated costs.

Good results with immediate implant placement after mastectomy

Dr. Crisera and co-authors report on the results of immediate implant-based breast reconstruction in 35 women with breast cancer. In this procedure, breast reconstruction with silicone-gel implant placement was performed immediately after mastectomy. The women's average age was 45 years; most underwent double mastectomy with immediate reconstruction of both breasts.

The immediate implant reconstruction technique was made possible by the use of modern surgical materials and approaches including "skin-sparing" mastectomy techniques that preserve the normal breast skin. The results were assessed an average of 15 months after surgery.

Six of the women had some type of complication-a rate of 16.6%. Only one of these complications was serious enough to cause loss of the implant. Overall, 37% of the women required additional surgery for revision.

The aesthetic results were rated good to excellent with an average score of 3.19 on a 1-to-4 rating scale. Complication and revision rates were higher for women who had undergone radiation therapy for breast cancer, who had large breasts (D-cup or larger), and who had ptotic (sagging) breasts. The same characteristics were also associated with lower aesthetic scores.

Immediate implant placement offers some potentially important advantages over other approaches to reconstruction after mastectomy. By avoiding the need for a separate reconstructive surgery, it reduces anesthesia and other surgical risks.

Immediate reconstruction may also lessen some of the psychological distress associated with mastectomy. In addition, it can reduce hospital days and costs. In the current study, the average hospital stay was less than two days.

Although more research is needed, the results suggest that immediate implant placement provides a valuable new approach to breast reconstruction after mastectomy. Dr. Crisera and co-authors conclude: "We believe that the possible advantages of immediate single stage implant based reconstruction, such as the potential to complete reconstruction with fewer operations and in less time and cost warrant its use in the appropriately selected patient."