TY - JOUR
T1 - Less is more? One-stage versus two-stage implant-based breast reconstruction
T2 - A systematic review and meta-analysis of comparative studies
AU - van der Wielen, Alexander
AU - Negenborn, Vera
AU - Burchell, George Louis
AU - Remmelzwaal, Sharon
AU - Lapid, Oren
AU - Driessen, Caroline
N1 - Publisher Copyright:
© 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background: Most breast reconstructions are implant-based and can be performed either in a one-stage, direct-to-implant or in a two-stage, expander-implant-based reconstruction. The objective of this systematic review is to compare the safety and patient satisfaction of the two reconstruction approaches. Methods: A literature search was conducted on 27 September 2022 using various databases. Studies comparing one-stage and two-stage implant reconstructions and reporting the following outcomes were included: patient satisfaction, aesthetics, complications, and/or costs. Reviews, case reports, or series with less than 20 patients and letters or comments were excluded. Comparisons were made between the one-stage reconstruction with and without acellular dermal matrix (ADM) and two-stage implant-based breast reconstruction groups. The data extracted from all articles were analysed using random-effects meta-analyses. Results: Of the 1381 records identified, a total of 33 articles were included, representing 21529 patients. There were no significant differences between the one-stage and two-stage groups, except for the costs. The one-stage operation without ADM had lower costs than the two-stage operation without ADM, although the use of an ADM substantially increased the price of the operation to more than a two-stage reconstruction. Discussion: Equal patient satisfaction, aesthetic outcomes, and complication rates with lower costs justify one-stage breast reconstruction in carefully selected patients. This review shows that there is no evidence-based superior surgical approach. Future research should focus on the costs of the ADM versus an additional stage and patient-reported outcomes.
AB - Background: Most breast reconstructions are implant-based and can be performed either in a one-stage, direct-to-implant or in a two-stage, expander-implant-based reconstruction. The objective of this systematic review is to compare the safety and patient satisfaction of the two reconstruction approaches. Methods: A literature search was conducted on 27 September 2022 using various databases. Studies comparing one-stage and two-stage implant reconstructions and reporting the following outcomes were included: patient satisfaction, aesthetics, complications, and/or costs. Reviews, case reports, or series with less than 20 patients and letters or comments were excluded. Comparisons were made between the one-stage reconstruction with and without acellular dermal matrix (ADM) and two-stage implant-based breast reconstruction groups. The data extracted from all articles were analysed using random-effects meta-analyses. Results: Of the 1381 records identified, a total of 33 articles were included, representing 21529 patients. There were no significant differences between the one-stage and two-stage groups, except for the costs. The one-stage operation without ADM had lower costs than the two-stage operation without ADM, although the use of an ADM substantially increased the price of the operation to more than a two-stage reconstruction. Discussion: Equal patient satisfaction, aesthetic outcomes, and complication rates with lower costs justify one-stage breast reconstruction in carefully selected patients. This review shows that there is no evidence-based superior surgical approach. Future research should focus on the costs of the ADM versus an additional stage and patient-reported outcomes.
KW - Breast implant
KW - Breast reconstruction
KW - Comparison study
KW - One-stage breast reconstruction
KW - Tissue expander
KW - Two-stage breast reconstruction
UR - http://www.scopus.com/inward/record.url?scp=85171424601&partnerID=8YFLogxK
U2 - 10.1016/j.bjps.2023.08.021
DO - 10.1016/j.bjps.2023.08.021
M3 - Review article
C2 - 37716248
AN - SCOPUS:85171424601
SN - 1748-6815
VL - 86
SP - 109
EP - 127
JO - Journal of Plastic, Reconstructive and Aesthetic Surgery
JF - Journal of Plastic, Reconstructive and Aesthetic Surgery
ER -