Complications and Burden of 2-Stage Tissue Expander to Implant-Based Reconstructive Surgery: A Single-Center Retrospective Study

Introduction: Two-stage reconstruction with a tissue expander/implant (TE/I) technique remains the most common breast reconstructive approach following mastectomy. This study analyzes the post-operative complications and burden associated with 2-stage TE/I reconstruction independent of acellular dermal matrix (ADM). Methods: A retrospective chart review identified patients that underwent 2-stage, reconstruction with TE/I without ADM. Demographics, implant characteristics, tissue expansion information, and complications were recorded. Patients were followed for 3 months post-implant exchange. Logistic regression analysis was used to determine which variables were predictors for complications. Results: Ninety-one TE/I reconstructions without ADM were performed in 55 patients. The incidence of complications was 45% (n = 25). Mean complications per patient was 0.84 ± 1.2, with the most common being infection with the TE (n = 15, 24.2%). Mean number of fill appointments was 3.6 ± 1.7 (range: 1-8). Univariate linear regression showed for every increase in BMI, there was a 14.8 cc increase in implant volume, on average (P < .001). Multivariable logistic regression model identified radiation history (P = .036) and increasing BMI (P = .049) as significant predictors for complications. Conclusion: Infection remains to be the leading cause of short-term complications in TE/I breast reconstruction patients. BMI and radiation are significant predictors. Larger, multicenter observational study data may elicit nuanced variation among different population demographics.