Breast reconstruction utilizing implants: a local experience and comparison of three techniques.

The breast reconstruction patient requires accurate information about the complications, failures, and additional surgeries associated with implant reconstruction. In this series of consecutive patients, we examine three methods of implant reconstruction: (1) immediate with a permanent implant/expander (86 patients/107 breasts), (2) delayed with a permanent implant/expander (57/73), and (3) delayed serial expansion with gel/saline (54/68). Implant/expander reconstructions had an equal interval to completion (immediate 118 days, delayed 127 days), a significant need for revisions (immediate 57 percent, delayed 30 percent), and a similar complication rate (10 percent) and failure rate (3.5 percent). The delayed serial expansion patients were completed with one operation 66 percent of the time, and only 9 percent required revisional surgery. The data obtained from the largest private health care provider in the state confirmed a significant difference (p = 0.003) in the need for revisional surgery between immediate and delayed reconstructions. The data showed immediate implant reconstructions to (1) be safe (low failure rate), (2) require more capsular intervention procedures, (3) have a greater expense, and (4) have good aesthetic results (90 percent Baker class I or II) because of revisional surgery. The immediate implant breast reconstruction patients are committed to their reconstruction and undergo revisional surgery to improve their aesthetic result. Delayed implant reconstruction patients are less likely to undergo further surgery to correct capsular deformities.