Two-stage Implant-based Breast Reconstruction Without the Use of Tissue Expanders.

Background: The use of a tissue expander (TE) followed by a definitive implant is the most common approach for breast reconstruction after mastectomy. The purpose of this study was to determine if a first-stage, low-projection definitive silicone implant could replace the use of a TE. Methods: Between January 2016 and January 2024, 155 consecutive high-risk patients with breast cancer underwent breast reconstruction with a first-stage definitive implant after mastectomy in the implant-only (IO) group. All IO patients underwent a subsequent second-stage implant exchange to get to their goal reconstruction size. Outcomes were compared with a similar high-risk population who underwent conventional 2-stage reconstruction with a first-stage TE. Results: The risk of all complications, including reconstructive failure, was similar between the groups, except for an increased risk of minor postoperative wounds in the IO group and a higher risk of seroma requiring operative drainage in the TE group. Conclusions: The success rate of 2-stage breast reconstruction in high-risk patients after mastectomy is similar using either a first-stage TE or low-projection definitive implant. Two-stage reconstruction using the IO approach offers patients the opportunity to reduce the cost, discomfort, inconvenience, and complications associated with repeated TE fills. It also allows them to pursue their second-stage reconstruction at their convenience when compared with patients with TEs who are encouraged to undergo exchange in a timely fashion.