Abstract and Introduction
Background: Infection is a dreaded complication of implant-based breast reconstruction. There is a paucity of literature on the outcomes of a secondary reconstruction after infected implant-based breast reconstruction explantation.
Methods: The authors conducted a retrospective study of patients who underwent a second implant-based breast reconstruction following a failed infected device between January of 2006 and December of 2019. Surgical and patient-reported outcomes (BREAST-Q) were collected and analyzed.
Results: A total of 6093 implant-based breast reconstructions were performed during the study period, 298 (5 percent) of which involved device removal because of infection. Eighty-three patients ultimately received 92 second-attempt breast implants. Thirty-six percent of cases developed at least one postoperative complication, with infection [23 breasts (25 percent)] being the most common. Compared with first-attempt implant-based breast reconstruction, we found significantly higher infection rates among second-attempt cases (9 percent and 21 percent, respectively; p = 0.0008). Patient-reported satisfaction with the breast and sexual well-being were lower after second-attempt than after first-attempt implant-based breast reconstruction (p = 0.018 and p = 0.002, respectively) reported in the literature. Mean follow-up was 41 ± 35 months. If we exclude patients with prior radiation therapy and those who received device exchange, the success rate is 88 percent.
Conclusions: It is reasonable to offer women second-attempt implant-based breast reconstruction after explantation because of infection. However, this patient population has a higher infection and explantation rate and lower patient-reported satisfaction than patients undergoing first-attempt implant-based breast reconstruction. Because of these increased surgical risks and elevated complication rates, patients must be given reasonable expectations during preoperative discussions and when providing informed consent for second-attempt implant-based breast reconstruction.
Clinical Question/Level of Evidence: Risk, III.
Implant-based breast reconstruction is the most commonly used method of breast reconstruction after mastectomy, with approximately 100,000 cases performed in the United States annually. Several studies have confirmed the safety of implant-based breast reconstruction and its positive effect on quality of life. However, complications that occur after this reconstruction modality are not uncommon.[2–15] In a multicenter cohort study of 2343 patients, the overall 2-year complication rate in direct-to-implant and tissue expander/implant reconstruction was 31 percent and 27 percent, respectively; infection rates were 15 percent for the former and 10 percent for the latter.
Infection is a dreaded complication of implant-based breast reconstruction and its management varies according to the severity of presentation. Over the past decade, there has been a shift in the treatment paradigm for infected implants, with many surgeons challenging the traditional doctrine of removing all infected devices.[16,17] Several immediate salvage techniques have been proposed, ranging from antibiotic therapy to operative intervention and implant replacement.[16,17] However, the subset of patients who do not respond to nonoperative management require implant explantation. Although several studies have evaluated the infection and complication rates of implant-based breast reconstruction and have identified several risk factors that predispose patients to implant failure,[3–5] the literature on the outcomes of those undergoing a second implant-based breast reconstruction after the first implant-based breast reconstruction is explanted is scarce.[17–19]
We hypothesized that second-attempt implant-based breast reconstruction, either at the time of device exchange or delayed after a failed infected device, is safe but has a higher risk of failure than a first-attempt implant-based breast reconstruction. Our primary goal was to assess surgical and patient-reported outcomes of breast reconstruction in this patient cohort. Our secondary goal was to identify potential risk factors for failure and complications of second-attempt implant-based breast reconstruction.
Plast Reconstr Surg. 2022;150(2):247e-259e. © 2022 Lippincott Williams & Wilkins