Risk factors for implant failure following revision surgery in breast cancer patients with a previous immediate implant-based breast reconstruction

A Frisell,J Lagergren,J De Boniface,M Halle

doi:10.1007/s10549-020-05911-z

Abstract

PurposeThe aim of the current study was to evaluate risk factors and timing of revision surgery following immediate implant-based breast reconstruction (IBR).MethodsThis retrospective cohort included women with a previous therapeutic mastectomy and implant-based IBR who had undergone implant revision surgery between 2005 and 2015. Data were collected by medical chart review and registered in the Stockholm Breast Reconstruction Database. The primary endpoint was implant removal due to surgical complications, i.e. implant failure.ResultsThe cohort consisted of 475 women with 707 revisions in 542 breasts. Overall, 33 implants were removed due to complications. The implant failure rate (4.7%) was lower without RT (2.4%) compared to RT administered after mastectomy (7.5%) and prior to IBR (6.5%) (p = 0.007). While post-mastectomy RT (OR 3.39, 95% CI 1.53–7.53), smoking (OR 3.90, 95% CI 1.76–8.65) and diabetes (OR 5.40, 95% CI 1.05–27.85) were confirmed as risk factors, time from completion of RT (> 9 months, 6–9 months, < 6 months) was not (OR 3.17, 95% CI 0.78–12.80, and OR 0.74, 95% CI 0.20–2.71). Additional risk factors were a previous axillary clearance (OR 4.91, 95% CI 2.09–11.53) and a history of a post-IBR infection (OR 15.52, 95% CI 4.15–58.01, and OR 12.93, 95% CI 3.04–55.12, for oral and intravenous antibiotics, respectively).ConclusionsPrevious axillary clearance and a history of post-IBR infection emerged as novel risk factors for implant failure after revision surgery. While known risk factors were confirmed, time elapsed from RT completion to revision surgery did not influence the outcome in this analysis.

Highlights

In accordance to national and international guidelines, immediate breast reconstruction (IBR) should be offered [1] when discussing mastectomy with breast cancer patients
One of the most important factors when planning for implant-based IBR is previous or post-mastectomy radiotherapy (PMRT)
All consecutive patients who had undergone ipsilateral breast implant revision surgery entering the implant cavity, e.g. implant exchange or capsulectomy, at Karolinska University Hospital between 2005 and 2015, and who had previously had a therapeutic mastectomy with implant-based IBR, were identified through their intervention codes

Summary

Introduction

In accordance to national and international guidelines, immediate breast reconstruction (IBR) should be offered [1] when discussing mastectomy with breast cancer patients. Radiotherapy (RT) causes chronic inflammatory changes and tissue remodelling [4], and may result in capsular contracture and tissue fibrosis with deteriorated cosmetic outcome, psychological distress and pain as potential complications [5]. As it negatively affects wound healing and tissue repair [4], it is acknowledged that any further ipsilateral revision surgery entering the implant cavity comes with a higher risk for wound complications and infection. In a previous publication from our group, as much as 77.7% of women receiving PMRT would recommend implant-based IBR to other women in their situation, while the corresponding figure was only 68.7% in women with RT prior to IBR [6]

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