Conflict of interest
Jung-Ju Huang is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.
Ethical approval
The study was approved by the Institutional Review Board of Chang Gung Medical Foundation (IRB Nos. 202000-235B0 and 202100103B0) and performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained.
Patient consent
The patients provided written informed consent for the publication and the use of their images.
Author contribution
Conceptualization: WL Kuo, SC Chen, JJ Huang. Data curation: WL Kuo, JJ Huang. Formal analysis: CL Su, JR Yang, JJ Huang. Methodology: WL Kuo, SC Chen, DC Cheong, JJ Huang. Project administration: WL Kuo, SC Chen, JJ Huang. Visualization: CL Su, JR Yang, WL Kuo, DC Cheong, JJ Huang. Writing - original draft: CL Su, JR Yang, JJ Huang. Writing - review & editing: WL Kuo, SC Chen, DC Cheong, JJ Huang.
Characteristics | Direct-to-implant group (n = 100) | Tissue expander group (n = 29) | P-value |
---|---|---|---|
Age (yr) | 44.17 ± 7.03 | 40.97 ± 8.70 | 0.043a) |
Body mass index (kg/m2) | 21.15 ± 2.54 | 22.91 ± 4.07 | 0.025a) |
History of smoking | 2 (2) | 0 | 1.000 |
Medical history | |||
Diabetes mellitus | 1 (1) | 2 (6.9) | 0.127 |
Hypertension | 2 (2) | 0 | 1.000 |
Previous breast cancer | 8 (8) | 2 (6.9) | 1.000 |
Previous mastectomy | 13 (13) | 3 (10.3) | 1.000 |
Previous lymph node dissection | 5 (5) | 0 | 0.584 |
Hospital stay (day) | 7.78 ± 2.46 | 7.17 ± 2.36 | 0.206 |
Follow-up time (mo) | 20.11 ± 23.22 | 14.61 ± 10.57 | 0.540 |
Characteristics | Direct-to-implant group (n = 100) | Tissue expander group (n = 29) | P-value |
---|---|---|---|
Side | 0.593 | ||
Left | 47 (47) | 12 (41.4) | |
Right | 53 (53) | 17 (58.6) | |
Location | 0.404 | ||
UOQ | 52 (52) | 14 (48.3) | |
LOQ | 17 (17) | 2 (6.9) | |
UIQ | 20 (20) | 8 (27.6) | |
LIQ | 11 (11) | 5 (17.2) | |
Distance from the nipple (cm) | 2.83 ± 1.28 | 2.66 ± 2.16 | 0.195 |
Histological type | 0.174 | ||
Ductal carcinoma in situ | 30 (30) | 5 (17.2) | |
Invasive carcinoma | 70 (70) | 24 (82.8) | |
T stage | 0.322 | ||
Tis | 20 (20) | 5 (17.2) | |
T1 | 50 (50) | 11 (37.9) | |
≥ T2 | 30 (30) | 13 (44.9) | |
N stage | 0.779 | ||
N0 | 75 (75) | 21 (72.4) | |
≥ N1 | 25 (25) | 8 (27.6) | |
M stage | 0.400 | ||
M0 | 99 (99) | 28 (96.9) | |
M1 | 1 (1) | 1 (3.10) | |
IHC type | |||
HR+ | 79 (79) | 24 (82.8) | 0.657 |
HER2+ | 29 (29) | 10 (34.5) | 0.571 |
Axillary lymph node dissection | 20 (20) | 9 (31.0) | 0.210 |
IORT targeting the NAC | 18 (18) | 3 (10.3) | 0.404 |
Neoadjuvant chemotherapy | 15 (15) | 8 (27.6) | 0.119 |
Adjuvant chemotherapy | 48 (48) | 16 (55.2) | 0.496 |
Hormone therapy | 55 (55) | 18 (62) | 0.499 |
PMRT | 11 (11) | 9 (31.0) | 0.009a) |
Contralateral augmentation | 14 (14) | 2 (6.9) | 0.522 |
Values are presented as number (%) or mean±SD.
UOQ, upper-outer quadrant; LOQ, lower-outer quadrant; UIQ, upper-inner quadrant; LIQ, lower-inner quadrant; IHC, immunohistochemistry; HR, hormone receptor; HER2, human epidermal growth factor receptor 2; IORT, intraoperative radiotherapy; NAC, nipple-areolar complex; PMRT, postmastectomy radiotherapy.
Characteristics | Direct-to-implant group (n = 100) | Tissue expander group (n = 29) | P-value |
---|---|---|---|
Incision placement of mastectomy | 0.570 | ||
Inframammary fold | 9 (9) | 3 (10.3) | |
Periareolar | 11 (11) | 6 (20.7) | |
Lateral | 57 (57) | 14 (48.3) | |
Other incisions | 23 (23) | 6 (20.7) | |
Specimen size (g) | 272.08 ± 126.33 | 317.37 ± 176.42 | 0.047c) |
Implant size (g) | 298.83 ± 81.13 | 360.84 ± 85.19 | 0.004c) |
Implant typea) | |||
Silicone | 95 (95) | 18 (100) | 1.000 |
Saline | 5 (5) | 0 | |
Implant surfacea) | 0.447 | ||
Texture | 40 (40) | 9 (50.0) | |
Smooth | 60 (60) | 9 (50.0) | |
Acute complications | |||
Overall | 19 (19) | 8 (23.1) | 0.317 |
Poor wound healing | 6 (6) | 3 (10.3) | 0.420 |
Skin flap necrosis | 8 (8) | 6 (20.7) | 0.053 |
Nipple necrosis | 3 (3) | 2 (6.9) | 0.313 |
Seroma | 1 (1) | 0 | 1.000 |
Hematoma | 1 (1) | 0 | 1.000 |
Infection | 4 (4) | 0 | 0.574 |
Late complications | |||
Overall | 21 (21) | 8 (27.6) | 0.454 |
Capsular contracture | 9 (9) | 1 (3.4) | 0.455 |
Implant/expander rupture | 4 (4) | 0 | 0.574 |
Implant/expander exposure | 1 (1) | 3 (10.3) | 0.035c) |
Wound dehiscence | 8 (8) | 5 (17.2) | 0.146 |
Infection | 6 (6) | 4 (13.8) | 0.231 |
Oncologic outcome | |||
Local recurrence | 1 (1.1) | 2 (7.7) | 0.127 |
Distant metastasis | 5 (5) | 1 (3.4) | 1.000 |
Implant/tissue expander removal | 6 (6) | 5 (17.2) | 0.069 |
Conversion to free flapb) | 0 | 6 (20.7) | < 0.001c) |
Revision aesthetic surgery | |||
Overall | 8 (8) | 0 | 0.197 |
Scar release | 4 (4) | 1 (3.4) | 1.000 |
Fat graft | 3 (3) | 0 | 1.000 |
Skin revision | 4 (4) | 0 | 0.574 |
Variable |
Acute complications |
Late complications |
||
---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | |
Age (yr) | ||||
< 50 | Reference | Reference | ||
≥ 50 | 4.63 (1.52–14.05) | 0.007b) | 2.03 (0.66–6.21) | 0.214 |
BMI (kg/m2) | ||||
< 25 | Reference | Reference | ||
≥ 25 | 1.07 (0.11–10.15) | 0.953 | 0.938 (0.10–8.86) | 0.955 |
History of smoking | - | - | - | - |
Medical history | ||||
Diabetes mellitus | - | - | - | - |
Hypertension | 4.44 (0.27–74.46) | 0.300 | - | - |
Previous breast cancer | 0.59 (0.07–5.08) | 0.629 | 0.51 (0.06–4.43) | 0.545 |
Previous mastectomy | 2.13 (0.58–7.85) | 0.254 | 1.15 (0.29–4.62) | 0.844 |
Previous lymph node dissection | 1.07 (0.11–10.15) | 0.953 | 0.94 (0.10–8.86) | 0.955 |
Tumor side | ||||
Left | Reference | Reference | ||
Right | 1.67 (0.60–4.68) | 0.327 | 0.60 (0.23–1.58) | 0.297 |
Tumor location | ||||
UOQ | Reference | Reference | ||
LOQ | 1.69 (0.44–6.53) | 0.445 | 0.64 (0.16–2.60) | 0.535 |
UIQ | 1.83 (0.52–6.47) | 0.346 | 0.53 (0.13–2.10) | 0.366 |
LIQ | 1.22 (0.22–6.74) | 0.818 | 0.67 (0.13–3.49) | 0.631 |
Tumor distance from the nipple | 1.14 (0.78–1.67) | 0.507 | 1.10 (0.76–1.60) | 0.607 |
Tumor histological type | ||||
Ductal carcinoma in situ | Reference | Reference | ||
Invasive carcinoma | 1.25 (0.41–3.85) | 0.697 | 0.63 (0.23–1.72) | 0.365 |
T stage | ||||
Tis | Reference | Reference | ||
T1 | 0.92 (0.21–3.99) | 0.914 | 0.58 (0.18–1.90) | 0.371 |
≥ T2 | 2.43 (0.57–10.40) | 0.232 | 0.47 (0.12–1.81) | 0.270 |
N stage | ||||
N0 | Reference | Reference | ||
≥ N1 | 1.51 (0.50–4.50) | 0.464 | 0.92 (0.30–2.84) | 0.887 |
M stage | ||||
M0 | Reference | Reference | ||
M1 | - | - | ||
Tumor IHC type | ||||
HR+ | 2.61 (0.55–12.31) | 0.227 | 0.81 (0.26–2.55) | 0.722 |
HER2+ | 0.40 (0.11–1.48) | 0.169 | 1.70 (0.62–4.68) | 0.304 |
Axillary lymph node dissection | 1.57 (0.49–5.04) | 0.447 | 0.61 (0.16–2.31) | 0.465 |
IORT targeting the NAC | 2.65 (0.84–8.34) | 0.095 | 2.23 (0.72–6.90) | 0.163 |
Neoadjuvant chemotherapy | 1.08 (0.27–4.27) | 0.915 | 0.23 (0.03–1.88) | 0.171 |
Adjuvant chemotherapy | 2.14 (0.77–6.00) | 0.147 | 0.35 (0.12–1.00) | 0.050 |
PMRT | 0.39 (0.05–3.29) | 0.390 | 0.35 (0.04–2.86) | 0.324 |
Incision placement of mastectomy | ||||
IMF | Reference | Reference | ||
Periareolar | 1.14 (0.18–7.28) | 0.888 | 0.20 (0.02–2.39) | 0.203 |
Lateral | 0.28 (0.06–1.38) | 0.118 | 0.43 (0.09–2.00) | 0.278 |
Other incisions | 0.56 (0.10–3.05) | 0.499 | 0.88 (0.17–4.54) | 0.874 |
Specimen size (100 g)a) | 1.80 (1.20–2.68) | 0.004b) | 1.09 (0.75–1.58) | 0.660 |
Specimen size–implant size (100 g)a) | 1.46 (0.88–2.41) | 0.142 | 1.55 (0.86–2.78) | 0.146 |
OR, odds ratio; CI, confidence interval; BMI, body mass index; UOQ, upper-outer quadrant; LOQ, lower-outer quadrant; UIQ, upper-inner quadrant; LIQ, lower-inner quadrant; IHC, immunohistochemistry; HR, hormone receptor; HER2, human epidermal growth factor receptor 2; IORT, intraoperative radiotherapy; NAC, nipple-areolar complex; PMRT, postmastectomy radiotherapy; IMF, inframammary fold.
Variable |
Implant removal |
Revision aesthetic surgery |
||
---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | |
Age (yr) | ||||
< 50 | Reference | Reference | ||
≥ 50 | 2.27 (0.38–13.39) | 0.367 | 1.47 (0.27–7.93) | 0.654 |
BMI (kg/m2) | ||||
< 25 | Reference | Reference | ||
≥ 25 | - | - | - | - |
History of smoking | - | - | - | - |
Medical history | ||||
Diabetes mellitus | - | - | - | - |
Hypertension | - | - | - | - |
Previous breast cancer | 2.49 (0.25–24.33) | 0.434 | - | - |
Previous mastectomy | 1.04 (0.12–9.43) | 0.971 | 0.95 (0.11–8.44) | 0.965 |
Previous lymph node dissection | 4.50 (0.42–48.10) | 0.213 | - | - |
Tumor side | ||||
Left | Reference | Reference | ||
Right | 0.88 (0.17–4.59) | 0.879 | 0.88 (0.21–3.72) | 0.859 |
Tumor location | ||||
UOQ | Reference | Reference | ||
LOQ | 3.33 (0.43–25.72) | 0.248 | 1.02 (0.10–10.52) | 0.986 |
UIQ | 1.32 (0.11–15.37) | 0.827 | 1.82 (0.28–11.76) | 0.532 |
LIQ | 2.50 (0.21–30.29) | 0.472 | 3.63 (0.53–24.89) | 0.189 |
Tumor distance from the nipple | 1.23 (0.67–2.26) | 0.500 | 1.40 (0.83–2.37) | 0.211 |
Tumor histological type | ||||
Ductal carcinoma in situ | Reference | Reference | ||
Invasive carcinoma | 2.23 (0.25–19.96) | 0.473 | 1.31 (0.25–6.91) | 0.748 |
T stage | ||||
Tis | Reference | Reference | ||
T1 | 0.39 (0.02–6.52) | 0.511 | - | - |
≥ T2 | 2.92 (0.30–28.29) | 0.354 | - | - |
N stage | ||||
N0 | Reference | Reference | ||
≥ N1 | 1.54 (0.27–8.98) | 0.629 | 0.41 (0.05–3.46) | 0.409 |
M stage | ||||
M0 | Reference | Reference | ||
M1 | - | - | - | - |
Tumor IHC type | ||||
HR+ | 1.35 (0.15–12.23) | 0.789 | 0.41 (0.09–1.86) | 0.245 |
HER2+ | 0.47 (0.05–4.22) | 0.501 | 0.56 (0.12–2.51) | 0.445 |
Axillary lymph node dissection | 0.79 (0.09–7.16) | 0.834 | 0.55 (0.06–4.74) | 0.585 |
IORT targeting the NAC | 2.44 (0.41–14.46) | 0.327 | 5.57 (1.25–24.93) | 0.025b) |
Neoadjuvant chemotherapy | - | - | - | - |
Adjuvant chemotherapy | 2.27 (0.40–13.01) | 0.356 | 1.09 (0.26–4.63) | 0.906 |
PMRT | 1.68 (0.18–18.86) | 0.651 | - | - |
Incision placement for mastectomy | ||||
IMF | Reference | Reference | ||
Periareolar | - | - | ||
Lateral | 0.13 (0.02–1.05) | 0.056 | 0.60 (0.06–6.11) | 0.669 |
Other incisions | 0.33 (0.04–2.83) | 0.314 | 1.20 (0.11–13.32) | 0.882 |
Specimen size (100 g)a) | 1.07 (0.57–2.02) | 0.826 | 1.40 (0.85–2.32) | 0.188 |
Specimen size–implant size (100 g)a) | 0.95 (0.45–2.01) | 0.888 | 1.28 (0.64–2.58) | 0.491 |
OR, odds ratio; CI, confidence interval; BMI, body mass index; UOQ, upper-outer quadrant; LOQ, lower-outer quadrant; UIQ, upper-inner quadrant; LIQ, lower-inner quadrant; IHC, immunohistochemistry; HR, hormone receptor; HER2, human epidermal growth factor receptor 2; IORT, intraoperative radiotherapy; NAC, nipple-areolar complex; PMRT, postmastectomy radiotherapy; IMF, inframammary fold.
Variable |
Acute complications |
Late complications |
Implant removal |
Revision aesthetic surgery |
||||
---|---|---|---|---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value | |
Age ≥ 50 yr | 5.43 (1.50–19.74) | 0.010 | - | - | - | - | - | - |
IORT targeting the NAC | 4.05 (1.07–15.27) | 0.039 | - | - | - | - | 5.57 (1.25–24.93) | 0.025 |
Adjuvant chemotherapy | - | - | NS | NS | - | - | - | - |
Incision placement for mastectomy | - | - | - | - | NS | NS | - | - |
Lateral | - | - | - | - | - | - | - | - |
Specimen size (100 g)a) | 1.65 (1.08–2.51) | 0.021 | - | - | - | - | - | - |