Immediate Single Stage Breast Reconstruction. a Single Centre Retrospective Analysis.

Background: The increasing number of skin and nipple sparing mastectomies made DTI breast reconstruction an excellent alternative to traditional two-stage surgery. The advantage of this technique is the possibility to obtain, at the time of mastectomy, a definitive result which eliminates the need for expansion with a low complication rate. The benefit for a vulnerable patient undergoing mastectomy for breast cancer treatment or prophylaxis is both practical and psychological: the result is an increased quality of life that is the final purpose of every breast reconstruction approach. The aim of this study is to analyse critically our experience, comparing our results with similar studies in literature, looking for an unceasing improvement.

Methods: The retrospective review includes all patients undergoing immediate implant reconstruction. Patients charts were reviewed for patient and surgical aspects, and the occurrence of any complication.

Results: Between April 2013 and December 2017, DTI reconstruction was performed in 216 sequential patients on a total of 251 breasts, at Humanitas Research Hospital. The number increased from 22 in 2013 to 62 in 2017. The average age and BMI were 46,95 years and 21,09 kg/ m². The average implant size was 245,11 cc, and 5,53% of reconstruction used ADM. Total complications included seroma (8,76%), hematomas (1,38%), skin necrosis (11,52%), infections (5,53) and capsular contracture III-IV (7,37%). Implant removal occurred in 3,68%. BMI emerged as a protective factor (p 0,02) for overall complication, whereas the BMI average value was very low. Infection rate increased with age (p 0,04).

Conclusion: The study confirms the safety of the DTI reconstruction and the low complication rate that relies strictly on appropriate patient selection and intraoperative valuation of skin envelope in the postmastectomy setting.