Patient-Reported Outcomes And Complications Comparison Of One-Stage/Two-Stage Breast Implant Reconstruction

Background: Breast cancer is one of the most important malignancies threatening the health of women around the world,with morbidity and mortality ranking first.Due to the development of diagnosis and treatment technology,the survival period of breast cancer patients is significantly longer than before.Therefore,the quality of life and psychosocial health of patients have been more important.Breast implant reconstruction is widely used in clinical because of its simple,easy,less trauma to patients and other advantages.The emergence of skin-sparing mastectomy and nipple-sparing mastectomy makes immediate breast reconstruction an important method for early breast cancer reconstruction.However,it is still controversial to choose one-stage or two-stage procedure for different patients.Therefore,we studied the patient-reported outcomes and complications of the one-stage and two-stage procedure.Methods: This retrospective single-center study included patients diagnosed breast cancer and undergone breast implant reconstruction in our hospital from February 2012 to December 2019.A total of 106 patients were included for complication analysis,including 97 patients who still had the implant and 9 patients who had the implant removed due to complications for one-stage group,while 118 patients for two-stage group,including 101 patients who retained their implant and 17 patients who had their expander or implant removed due to complications.The Breast-Q questionnaire was further completed for patients who retained the implant to study satisfaction and health-related quality of life.Finally,69 patients completed the preoperative part and 72 patients completed the postoperative part for one-stage group,which 56 and 63 patients for two-stage group.Results: The mean follow-up time was 36.2 months.For incision infection(8.49% vs 7.63%),hematoma(0.94% vs 0.85%),seroma(0.94%vs 2.54%),incision rupture(3.77% vs 3.39%),and necrosis of the nipple and areola complex(3.45% vs 2.22%),There was no significant difference between one-stage and two-stage group(P > 0.05).For infection(2.83% vs6.78%),implant rupture(0.94% vs 4.24%,P = 0.27),bleeding(0.94% vs5.93%,P = 0.10),and implant loss(14.41% vs 8.49%,P = 0.24),the two-stage group was slightly higher than one-stage,but there was no statistical difference.Postoperative breast satisfaction,psychosocial well-being,physical well-being and sexual well-being were not significantly different between one-stage and two-stage group.Postoperative satisfaction with care of two-stage group was slightly higher than one-stage group.Conclusion: There is no significant difference in complications and patient-reported outcomes between one-stage and two-stage implant reconstruction.In clinical,individualized reconstructive surgery plans for patients should be comprehensively formulated according to various factors such as tumor characteristics,lymph node status and radiotherapy,so as to achieve better aesthetic and psychosocial rehabilitation effects.Selecting patients without postoperative radiotherapy and with appropriate breast volume,one-stage implant reconstruction can achieve the same aesthetic effect,patient satisfaction and HRQo L as two-stage procedure,while reducing the burden and pain for patients.Therefore,one-stage implant reconstruction can also be an important option for suitable patients.