Direct-to-implant breast reconstruction: an analysis of 1612 cases from the ACS-NSQIP surgical outcomes database.

There is continued debate about the outcomes of direct-to-implant (DTI) breast reconstruction when compared to a two-stage expander/implant approach. The purpose of this study was to examine outcomes after DTI reconstruction utilising the American College of Surgeons-National Surgical Quality Improvement (ACS-NSQIP) database. This study reviewed the 2005-2010 ACS-NSQIP databases identifying encounters with common procedural terminology codes for DTI (19340) (mastectomy and immediate implant placement). A composite variable of "major surgical complications" (deep infection, return to OR, device loss) was used as the dependent variable in the analysis. Logistic regression analysis was performed to assess for pre- and intraoperative factors associated with the occurrence of "major surgical complications". Overall, 1612 patients underwent one stage, DTI reconstruction with an average age of 50.8 ± 10.7 years with a body mass index (BMI) (kg/m2) of 26.9 ± 6.3 kg/m2. The incidence of major surgical complications was 9%. A multivariate regression analysis revealed obesity (OR = 1.54, p = 0.03), active smoking (OR = 1.60, p = 0.044), and prolonged operative time (>1 SD above average) (OR = 1.88, p = 0.002) were associated with surgical morbidity. The results of the analysis emphasize that DTI-based breast reconstruction can be an excellent option for a specific group of patients. Careful pre-operative patient selection will optimise outcomes, and caution must be used in assessing suitability of DTI in obese patients and active smokers.