Plastic and reconstructive surgery
September 3, 2026 · via Europe PMC
The Strategic Interval: Outcomes and Implications of the Staged Approach For Early Direct-to-Implant (SAFE-DTI) Breast Reconstruction.
Badiee RK, Wicklund T, Wang D, Stein IC.
AI summary — for doctors, generated from the abstract only
In a case series of 19 patients (32 breasts), a staged approach placing permanent implants 1-3 weeks after mastectomy (rather than immediately) was used to mitigate risk factors like flap necrosis concerns or pathology uncertainty, achieving an overall complication rate of 18.8% with no implant losses reported.
What was studied
A retrospective review of 19 patients (32 breasts) who underwent the Staged Approach For Early Direct-to-Implant (SAFE-DTI) breast reconstruction protocol at a single institution (2021-2025), in which permanent implants were placed 1-3 weeks post-mastectomy in patients otherwise eligible for immediate direct-to-implant reconstruction but with elevated flap necrosis risk, pathologic diagnosis uncertainty, or scheduling/logistic challenges.
Key findings
- Most patients (96.9%) underwent nipple-sparing mastectomy followed by SAFE-DTI, with a median implant volume of 398cc.
- Overall complication rate was 18.8%, including infection (6.3%, two breasts in one patient), hematoma (3.1%, one breast), and partial nipple-areolar complex necrosis (9.4%, three breasts, all initially noted prior to implant placement).
- Four patients (8 breasts, 25% of total) underwent revision within 6 months, primarily autologous fat grafting for aesthetic optimization; the technique allowed avoidance of tissue expanders in salvage cases when intraoperative perfusion was a concern.
Clinical relevance
This may be relevant to breast reconstruction surgeons managing patients with elevated flap necrosis risk, pathology uncertainty, or scheduling challenges, offering a practical staged alternative that leverages improved tissue perfusion over a short delay while preserving the benefits of direct-to-implant reconstruction and avoiding tissue expanders, as the authors describe.
Who should care
Limitations
Small case series (19 patients, 32 breasts) from a single institution without a comparison group (e.g., immediate DTI or two-stage expander reconstruction), limiting ability to determine whether SAFE-DTI produces better outcomes than these alternatives for similar higher-risk patients.
A staged protocol delaying implant placement 1-3 weeks after mastectomy was used successfully in select higher-risk patients, achieving reasonable complication rates while avoiding tissue expanders, in this small case series of 19 patients.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Implant-based breast reconstruction often presents a binary choice: immediate direct-to-implant (DTI) reconstruction or two-stage tissue expander-based reconstruction. Here, we present outcomes of the Staged Approach For Early Direct-to-Implant DTI (SAFE-DTI) protocol in which permanent implants are placed one to three weeks post-mastectomy. Patients undergoing SAFE-DTI were those otherwise eligible for immediate DTI reconstruction in whom (1) there was elevated risk of post-mastectomy flap necrosis, (2) uncertainty regarding their pathologic diagnosis, or (3) logistic challenges between the oncologic and reconstructive surgeon. We reviewed a cohort of 19 patients (32 breasts) who underwent SAFE-DTI at our institution between 2021 and 2025. Most patients underwent nipple-sparing mastectomy (96.9%) followed by SAFE-DTI with a median implant volume of 398cc (IQR 264cc-445cc). The overall complication rate was 18.8%, including infection (6.3%, two breasts in one patient), hematoma (3.1%, one breast) and partial nipple-areolar complex necrosis (9.4%, three breasts, all initially noted prior to implant placement). Four patients (8 breasts, 25% of total) underwent revision within 6 months which consisted primarily of autologous fat grafting for aesthetic optimization. For planned cases, SAFE-DTI leverages the delay phenomenon for improved tissue perfusion, allows confirmation of final pathology, and overcomes logistical scheduling challenges. In salvage cases, it enables the avoidance of tissue expanders when intraoperative tissue perfusion is a concern and immediate DTI is aborted. SAFE-DTI represents a practical technique to mitigate common barriers to immediate DTI reconstruction while preserving its benefits for appropriately selected patients.
DOI
10.1097/prs.0000000000013424
PMID
42695805
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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