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 with patients who underwent delayed tissue expander to implant-based reconstruction.

Results: A total of 36 patients (64 breasts) were included in the study (31 TE and 33 dDTI breasts). The average age was 52 ± 13 years, and average body mass index was 26.3 ± 4.8 kg/m2. The mean time between mastectomy and dDTI was 278.9 ± 180.2 days. dDTI had fewer complications than TE (3.0% vs 35.5%, P < 0.01). Univariate logistic regression showed that patients with dDTI had significantly lower odds of having complications compared with TE (odds ratio, 0.06 [0.01-1.22]; P < 0.01).

Conclusions: dDTIs appear to be a safe alternative to TE, especially when implant-based reconstruction is not feasible. This technique saves the patient, at minimum, an additional surgery and multiple clinic visits that would have been required if tissue expanders were used.