Exposed Implant after Immediate Breast Reconstruction - Presentation and Analysis of a Clinical Management Protocol.

Karina Furlan Anselmi,Rafael Amin Menezes Hassan,Cleverton Cesar Spautz,Iris Rabinovich,Eduardo Schunemann Jr,Rubens Silveira De Lima,Maíra Teixeira Dória,Cícero De Andrade Urban,Bernardo Passos Sobreiro,Flávia Kuroda

doi:10.1055/s-0041-1735939

Abstract

Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the original implant. Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.

Highlights

Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap
The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant
Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis

Summary

Introduction

The rate of postmastectomy breast reconstruction (PMBR) has increased worldwide.[1,2,3,4,5] In the United States, there was an increase of 35% between 2000 and 2017, with more than 100 thousand procedures performed in 2017.6 In Brazil’s public health system, the rate of PMBRs increased from 15% in 2008 to 29% in 2014.3 Breast reconstruction is associated with cosmetic and psychosocial benefits, and improvements in quality of life.[7,8,9,10] Among the different types of breast reconstruction, implant-based surgery is the most common option.[1,2,11] Several studies[12,13,14,15] have already demonstrated that this type of reconstruction is not associated with a negative impact on the oncologic results of breast cancer treatment, or with an increased risk of developing postoperative complications when compared with mastectomy alone.Of all possible complications, implant infection and exposure remain major concerns, as they can lead to implant loss and bad cosmetic results.[7,16,17,18] The rate of implant infection varies between 1% and 35.4%, and exposure occurs in 0.25% to 8.3% of all implant-based breast reconstructions.[19,20,21,22,23] Several factors are associated with implant infection and exposure: chemotherapy, radiotherapy, tumor size, obesity, older age, axillary dissection, smoking, and the comorbidities of the patient.[16,19,24,25].

Methods

Results

Discussion

Conclusion