An Analysis of the Motivating and Risk Factors for Conversion from Implant-Based to Total Autologous Breast Reconstruction

Tadiparthi, Sujatha; Staley, Helen; Collis, Nicholas; O’Donoghue, J.M.

doi:10.1097/prs.0b013e318290f83e

Cited by 21 publications

(9 citation statements)

References 19 publications

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“…Por el contrario, para Atherton y col. (12), Damen y col. (13) y Novo Torres y col. (18), el coste de la reconstrucción con colgajo DIEP es superior al de la reconstrucción con E-P; sin embargo, estos estudios presentan periodos de seguimiento menores al de los autores anteriores y al nuestro, con lo que no pueden incluir las complicaciones o cambios en el resultado de la reconstrucción que pueden aparecer tardíamente, sobre todo, en las pacientes reconstruidas con implantes. Numerosas publicaciones afirman que éstas pueden desarrollarse en un amplio rango de tiempo que oscila entre 1,5 años y 11 años (23)(24)(25)(26). Para Clough y col. (27,28), a los 5 años, un 94% de las pacientes reconstruidas con tejido autólogo permanece estable, mientras que el 30% de las reconstruidas con implantes precisan una revisión quirúrgica por deterioro de las prótesis.…”

Section: Discussionunclassified

Coste preciso de la reconstrucción mamaria con colgajo DIEP e implantes en un hospital público del sistema sanitario español

Lagares-Borrego

Gacto-Sánchez

Infante-Cossío

et al. 2015

Cir. plást. iberolatinoam.

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Section: Discussionunclassified

Coste preciso de la reconstrucción mamaria con colgajo DIEP e implantes en un hospital público del sistema sanitario español

Lagares-Borrego

Gacto-Sánchez

Infante-Cossío

et al. 2015

Cir. plást. iberolatinoam.

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“…We will use a cycle length of 3 months to track changes in costs and QALYs. Given that a secondary reconstruction can take place many years after the primary one, 12 we will run our model over a lifetime horizon. The cycle-specific probability of survival will be derived from age-specific and sex-specific Office of National Statistics (ONS) cancer survival statistics for women diagnosed with breast cancer.…”

Section: Methods and Analysismentioning

confidence: 99%

“…Furthermore, over a quarter (27.6%) of patients who initially had implant BR required a secondary reconstruction (replacement of their implant with another form of BR) over the same period. 10 The mean follow-up in this cohort was only 3.7 years, but as the median time to secondary reconstruction is between 4 11 and 6 years 12 , this may underestimate the true scale of the problem, providing further impetus for the long-term outcomes of implant-based and autologous BR to be explored.…”

Section: Introductionmentioning

confidence: 95%

Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: the brighter study

Johnson

Holcombe²,

O’Donoghue

et al. 2021

BMJ Open

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IntroductionBreast reconstruction (BR) is offered to improve quality of life for women with breast cancer undergoing mastectomy. As most women will be long-term breast cancer survivors, high-quality information regarding the long-term outcomes of different BR procedures is essential to support informed decision-making. As different techniques vary considerably in cost, policymakers also require high-quality cost-effectiveness evidence to inform care. The Brighter study aims to explore the long-term clinical and patient-reported outcomes (PROs) of implant-based and autologous BR and use health economic modelling to compare the long-term cost-effectiveness of different reconstructive techniques.Methods and analysisWomen undergoing mastectomy and/or BR following a diagnosis of breast cancer between 1 January 2008 and 31 March 2009 will be identified from hospital episode statistics (HES). Surviving women will be contacted and invited to complete validated PRO measures including the BREAST-Q, EQ-5D-5L and ICECAP-A, or opt out of having their data included in the HES analysis. Long-term clinical outcomes will be explored using HES data. The primary outcome will be rates of revisional surgery between implant-based and autologous procedures. Secondary outcomes will include rates of secondary reconstruction and reconstruction failure. The long-term PROs of implant-based and autologous reconstruction will be compared using BREAST-Q, EQ-5D-5L and ICECAP-A scores. Multivariable regression will be used to examine the relationship between long-term outcomes, patient comorbidities, sociodemographic and treatment factors. A Markov model will be developed using HES and PRO data and published literature to compare the relative long-term cost-effectiveness of implant-based and autologous BR.Ethics and disseminationThe Brighter study has been approved by the South-West -Central Bristol Research Ethics Committee (20/SW/0020), and the Confidentiality Advisory Group (20/CAG/0021). Results will be published in peer-reviewed journals and presented at national meetings. We will work with the professional associations, charities and patient groups to disseminate the results.

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“…Risk factors for failure of alloplastic reconstruction include larger breast size, active smoking, implant exposure, radiation, and periprosthetic infection. [8][9][10][11][12][13][14] Reconstruction failure attributed to patient-driven motivation from dissatisfaction with implant-based reconstruction or from physical discomfort is also described. 9,13,[15][16][17] Conversion to an autologous reconstruction has been shown to improve the aesthetic result, patient satisfaction, and quality of life in these difficult cases.…”

Section: Introductionmentioning

confidence: 99%

Conversion from Alloplastic to Autologous Breast Reconstruction: What Are the Inciting Factors?

et al. 2022

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Introduction: Failure of alloplastic breast reconstruction is an uncommon occurrence that may result in abandonment of reconstructive efforts or salvage with conversion to autologous reconstruction. The purpose of this study was to identify factors that predict failure of alloplastic breast reconstruction and conversion to autologous reconstruction. Methods: A retrospective chart review was conducted of patients who underwent mastectomy and immediate alloplastic breast reconstruction between 2008 and 2019. Inclusion criteria included patients 18 years or older who underwent initial alloplastic reconstruction with a minimum of 3-year follow-up. Data collected included age, body mass index, cancer type, surgical characteristics, neo/adjuvant treatment details, and complications. Results were analyzed using Fischer's exact test, t-test, and multivariate logistic regression. Results: A total of 234 patients met inclusion criteria. Of those, 23 (9.8%) required conversion from alloplastic to autologous reconstruction. Converted patients had a mean age of 50.1 ± 8.5. The time from initial alloplastic reconstruction to conversion was 30.7 months. The most common reasons for conversion included soft tissue deficiency (48%), infection (30%), and capsular contracture (22%). Patients were converted to deep inferior epigastric perforator flap (DIEP; 52%), latissimus dorsi flap with implant (26%), and DIEP with implant (22%). Multivariate logistic regression modeling identified radiation (OR 8.4 [CI = 1.7-40.1]) and periprosthetic infection (OR 14.6 [CI = 3.4-63.8]) as predictors for conversion. Conclusions: Among patients undergoing mastectomy with immediate alloplastic breast reconstruction, those treated with radiation have 8.4 greater odds of conversion and those with a periprosthetic infection have 14.6 greater odds for conversion to an autologous reconstruction.

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An Analysis of the Motivating and Risk Factors for Conversion from Implant-Based to Total Autologous Breast Reconstruction

Abstract: Risk, III.

Cited by 21 publications

References 19 publications

Coste preciso de la reconstrucción mamaria con colgajo DIEP e implantes en un hospital público del sistema sanitario español

Coste preciso de la reconstrucción mamaria con colgajo DIEP e implantes en un hospital público del sistema sanitario español

Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: the brighter study

Conversion from Alloplastic to Autologous Breast Reconstruction: What Are the Inciting Factors?

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An Analysis of the Motivating and Risk Factors for Conversion from Implant-Based to Total Autologous Breast Reconstruction

Abstract: Risk, III.

Cited by 21 publications

References 19 publications

Coste preciso de la reconstrucción mamaria con colgajo DIEP e implantes en un hospital público del sistema sanitario español

Coste preciso de la reconstrucción mamaria con colgajo DIEP e implantes en un hospital público del sistema sanitario español

Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: the brighter study

Conversion from Alloplastic to Autologous Breast Reconstruction: What Are the Inciting Factors?

Contact Info

Product

Resources

About

Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: the brighter study