From 0 to 100: Delayed Direct to Implant Breast Reconstruction, an Alternative to Tissue Expansion

Introduction: Implant based reconstruction is not always feasible when mastectomy flap viability is poor. Rather than returning to the operating room for staged breast reconstruction with tissue expansion (TE), patients may instead opt for delayed direct to implant (dDTI) reconstruction. This study aimed to assess the feasibility of dDTI after patients "go flat" after their mastectomy. Methods: Patients unable to undergo breast reconstruction at the time of their mastectomy and who later underwent implant placement without tissue expanders between 2022 and 2024 were included in this study. These patients were compared to patients who underwent tissue expander to implant based reconstruction. A loose BMI and radiation-matched subsample was created for subanalysis. Results: A total of 66 patients or 103 breasts were included in the study (77 TE and 26 dDTI breasts). The average age was 48 ± 11 years, and average BMI was 27.2 ± 5.3 kg/m2. The mean time between mastectomy and dDTI was 132.8 ± 182.2 days. dDTI had less complications than TE (4.8% vs 32.1%, p = 0.01). Patients with TE had significantly higher odds of having complications compared to dDTI (odds ratio, 9.4 [1.2 – 74.3], p = 0.03). Conclusions: dDTIs appear to be a safe alternative to tissue expansion, especially when implant based reconstruction is not feasible due to poor blood supply on SPY angiography. This technique saves the patient, at minimum, an additional surgery and multiple clinic visits that would have been required if tissue expanders were used.