{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T08:58:07Z","timestamp":1791017887578,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The choice between direct\u2010to\u2010implant (DTI) and two\u2010stage tissue expander\/implant (TE\/I) breast reconstruction remains debated. This study aimed to compare complication profiles between these techniques and evaluate the modifying effect of postoperative radiotherapy in a large Asian cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single\u2010center analysis was performed on patients who underwent immediate prosthetic breast reconstruction from 2014 to 2023. Patients were grouped by DTI or TE\/I. Propensity score full matching was used to balance baseline covariates. Subgroup analysis by postoperative radiotherapy status was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      569 female patients (600 breasts) were included. 437 patients (465 breasts) underwent DTI and 132 patients (135 breasts) underwent TE\/I breast reconstruction. After full matching on the propensity score, the TE group had significantly higher risks of any complication (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.002), reconstructive failure (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), implant or expander removal (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), and exposure of implant or expander (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) compared with the DTI group. In the subgroup analysis, TE\/I had higher risks of failure, removal, and exposure in the non\u2010radiotherapy subgroup, whereas in the radiotherapy subgroup most complications showed no intergroup differences, and TE\/I had a significantly lower risk of flap necrosis (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TE group had higher complication rates than DTI group, but postoperative radiotherapy significantly modifies the risk profile. In irradiated patients, TE may offer a protective effect against flap necrosis. These findings provide evidence\u2010based guidance for individualized surgical decision\u2010making in Asian populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70598","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T08:52:02Z","timestamp":1791017522000},"source":"Crossref","is-referenced-by-count":0,"title":["Direct\u2010to\u2010Implant Versus Two\u2010Stage Tissue Expander\/Implant Reconstruction: A Decade of Institutional Experience From China"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5683-2020","authenticated-orcid":false,"given":"Cong","family":"Su","sequence":"first","affiliation":[{"name":"The Department of Oncoplastic Breast Surgery Tianjin Medical University Cancer Institute and Hospital  Tianjin China"},{"name":"National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Treatment  Tianjin China"},{"name":"Tianjin's Clinical Research Center for Cancer The Sino\u2010Russian Joint Research Center for Oncoplastic Breast Surgery  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Wang","sequence":"additional","affiliation":[{"name":"The Department of Oncoplastic Breast Surgery Tianjin Medical University Cancer Institute and Hospital  Tianjin China"},{"name":"National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Treatment  Tianjin China"},{"name":"Tianjin's Clinical Research Center for Cancer The Sino\u2010Russian Joint Research Center for Oncoplastic Breast Surgery  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6735-2834","authenticated-orcid":false,"given":"Shanshan","family":"He","sequence":"additional","affiliation":[{"name":"The Department of Oncoplastic Breast Surgery Tianjin Medical University Cancer Institute and Hospital  Tianjin China"},{"name":"National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Treatment  Tianjin China"},{"name":"Tianjin's Clinical Research Center for Cancer The Sino\u2010Russian Joint Research Center for Oncoplastic Breast Surgery  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiqing","family":"Zhao","sequence":"additional","affiliation":[{"name":"The Department of Oncoplastic Breast Surgery Tianjin Medical University Cancer Institute and Hospital  Tianjin China"},{"name":"National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Treatment  Tianjin China"},{"name":"Tianjin's Clinical Research Center for Cancer The Sino\u2010Russian Joint Research Center for Oncoplastic Breast Surgery  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Yin","sequence":"additional","affiliation":[{"name":"The Department of Oncoplastic Breast Surgery Tianjin Medical University Cancer Institute and Hospital  Tianjin China"},{"name":"National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Treatment  Tianjin China"},{"name":"Tianjin's Clinical Research Center for Cancer The Sino\u2010Russian Joint Research Center for Oncoplastic Breast Surgery  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.815498"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2022.04.012"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000000908"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/gox.0000000000004180"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013821.pub2"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2022.11.044"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.4432"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/gox.0000000000004818"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2020\u20100001"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/sap.0000000000002125"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000002267"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.21147\/j.issn.1000\u20109604.2021.01.04"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25238"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13144168"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000010066"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000009979"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000001749"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534\u2010196605000\u201000011"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534\u2010197812000\u201000004"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957\u2010024\u201003576\u20102"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2019.09.001"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjae218"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010025\u201005070\u2010w"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/22925503221141708"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2024.09.053"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.14730\/aaps.2022.00689"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2023.08.021"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjae054"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.11.008"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010022\u201003136\u20107"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000012415"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/sap.0000000000003887"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2025.110511"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2017.08.023"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/js9.0000000000001235"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.14070"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/sap.0000000000000653"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16172939"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2022.06.063"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13287\u2010024\u201003822\u20100"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70598","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70598","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70598","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T08:52:03Z","timestamp":1791017523000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,3]]},"references-count":41,"alternative-id":["10.1002\/wjs.70598"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70598","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,3]]},"article-number":"wjs.70598"}}