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 breastreconstructive approach following mastectomy. This study analyzes the post-operative complications and burden associatedwith 2-stage TE/I reconstruction independent of acellular dermal matrix (ADM).Methods:A retrospective chart review iden-tified patients that underwent 2-stage, reconstruction with TE/I without ADM. Demographics, implant characteristics, tissueexpansion 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-oneTE/I reconstructions without ADM were performed in 55 patients. The incidence of complications was 45% (n=25). Mean com-plications per patient was 0.84 +/- 1.2, with the most common being infection with the TE (n=15, 24.2%). Mean number offillappointments was 3.6 +/- 1.7 (range: 1-8). Univariate linear regression showed for every increase in BMI, there was a 14.8 ccincrease 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 leadingcause 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.