D133. One And Done?: Predictors Of Revision And Additional Operations Following Two-stage Tissue Expander To Implant-based Breast Reconstruction

PURPOSE: Two-stage tissue expander (TE) to implant breast reconstruction is the most common form of reconstruction following mastectomy, but there is a paucity of literature investigating predictors of reoperation. This study aimed to evaluate variables associated with undergoing revision procedures following TE to implant reconstruction. METHODS: We retrospectively examined patients who underwent two-stage TE to implant breast reconstruction from 2017-2023. The definition of revision surgery included any procedure occurring after the date of implant placement. RESULTS: 2,177 patients met inclusion criteria, of which 435 underwent revision procedures following TE to implant exchange. Implant-to-implant exchange (56%), breast revision (33%), and fat grafting (30%) were the most common subsequent procedures that patients underwent. A Cox regression model demonstrated that Asian race and unilateral reconstruction were protective against additional procedures. Current smoking status (HR=1.64, 95% CI: 1.03,2.59, p=0.035) and implant placement under a latissimus flap (HR=1.87, 95% CI: 1.16,3.01, p=0.010) increased the risk of revision procedures. When patients were stratified by preoperative BREAST-Q score quartiles, the probability of no revision surgery decreased with increased time in all cohorts. Importantly, patients who had lower preoperative BREAST-Q scores were significantly more likely to undergo revision surgery at all time points (p<0.001). CONCLUSION: Smoking status and the plane of implant placement significantly influence patient likelihood of revision procedures. Furthermore, providers should identify and counsel patients with low preoperative BREAST-Q scores that they are more likely to undergo revision procedures, possibly due to correlating decreased postoperative satisfaction.