A Comparative Analysis Of Complications After Hybrid Versus Implant-only Breast Reconstruction

Purpose: Hybrid breast reconstruction provides the benefits of autologous reconstruction to patients who also desire the additional volume from implants. However, there is limited evidence regarding how these patients fare compared to those undergoing implant-based reconstruction alone. The present study investigates the impact of hybrid versus implant-only reconstruction on complication rates. Methods: A retrospective review was conducted of patients undergoing hybrid breast reconstruction (deep inferior epigastric perforator [DIEP] flap and implant) and implant-only reconstruction from 2014-2022 at a single institution. Demographic data, complication rates, and information regarding additional interventions were collected. Frequency and binary logistic regression analyses were used to compare outcomes between hybrid and implant-only groups. Results: 90 patients (138 breasts) were included in this study (hybrid, n=47 in 29 patients; implant-only, n=91 in 61 patients) with a mean follow-up time of 18.6 months. Age, BMI, diabetes history, smoking history, and ASA class were similar between the two groups. Patients in the hybrid group were less associated with infections than the patients in the implant-only group (3.4% vs 32.8%, OR = 0.053, P = 0.007). All infections in the hybrid group resolved with oral antibiotics alone. Of the infections in the implant-only group, 38.1% required hospitalization for intravenous antibiotics and 23.8% required debridement and explantation. While the patients in the hybrid group were more associated with capsular contracture (31.0 vs. 11.5%, OR = 3.84, P = 0.041), rates of capsulectomy were similar (27.6% vs 21.3%, P = 0.20). There were no significant differences in hematoma, seroma, dehiscence, or implant failure rates between the two groups. No patients in the hybrid group experienced total or partial flap loss. Conclusion: Hybrid breast reconstruction may decrease the incidence and severity of implant-associated infections without affecting the viability of the flap or increasing wound healing complications. The addition of the DIEP flap in hybrid reconstruction provides increased perfusion and tissue oxygenation in the reconstructed breast, which consequently promotes microbial resistance and wound healing. The relationship of hybrid breast reconstruction with capsular contracture requires further exploration, though capsulectomy rates remained similar. Thus, hybrid breast reconstruction may be a safe alternative for patients who desire the aesthetic benefits of both procedures while avoiding the negative sequelae of implant-associated infections.