Autologous Breast Reconstruction after Failed Implant-Based Reconstruction: Evaluation of Surgical and Patient-Reported Outcomes and Quality of Life

Abstract

Introduction: There is a subset of patients who initially had implant based breast reconstruction but later change to autologous reconstruction after failure of the implant reconstruction. The purpose of this study was to examine our series of patients in whom autologous reconstruction was performed after initial failed implant reconstruction, using the BREAST-Q to examine patient satisfaction and quality of life. Methods: After Institutional Review Board approval, a retrospective chart review of a prospectively maintained database was performed as well as evaluation of BREAST-Q surveys. Results: One hundred thirty-seven patients underwent autologous breast reconstruction following failed implant based reconstruction with 192 total flaps. Failure of implant reconstruction was defined as follows: capsular contracture causing pain and/or cosmetic deformity (n=106, 77%), dissatisfaction with the aesthetic result without capsular contracture (n=15, 11%), impending exposure of the implant/infection (n=8, 6%), and unknown (n=8, 6%). Complications requiring operative intervention included: partial flap loss (n=5, 3%), hematoma (n=5, 3%), vascular compromise requiring intervention for salvage (n=2, 1%), and total flap loss (n=1, 1%). Thirtyfour patients (23%) had BREAST-Q surveys available for analysis both during implant and autologous phases of reconstruction. There was a statistically significant increase in satisfaction with appearance of breasts(p<0.001), psychosocial well-being(p<0.001), and physical well-being of the chest(p=0.003). Satisfaction with overall outcomes also significantly increased(p<0.001). A statistically significant decrease in physical well-being of the abdomen was observed(p=0.001). Conclusion: Autologous breast reconstruction after failed implant based reconstruction is associated with significantly improved patient satisfaction and quality of life. The procedure has an acceptable complication rate.

Assessing the Influence of Failed Implant Reconstruction on Patient Satisfaction and Decision Regret after Salvage Free-Flap Breast Reconstruction

“…Prior studies have reported that in the setting of salvage free-flap breast reconstruction, complication rates may range from 7 to 21%; however, few studies have examined how complications may compare with patients who have not had a prior implant-based reconstruction. 5 6 24 Our study finds that patients with a history of implant reconstruction experienced a higher rate of major complications following free-flap reconstruction as compared with patients with no reconstructive history. This is likely related to a patient's history of radiation therapy and multiple reconstructive surgeries prior to free-flap reconstruction.…”

“…Previous studies have shown that free-flap breast reconstruction after failed implant reconstruction leads to improved patient outcomes. 5 6 7 More specifically, Coriddi et al compared outcomes in patients who had BREAST-Q scores available for both the implant and autologous phase of reconstruction, demonstrating that patients who underwent autologous reconstruction after failed implant reconstruction experienced significant improvement in satisfaction with their breasts, psychosocial well-being, and physical well-being. 6 However, the degree of satisfaction achieved after failed implant-based reconstruction as compared with a patient with no prior implant reconstruction remains unknown.…”

“…5 6 7 More specifically, Coriddi et al compared outcomes in patients who had BREAST-Q scores available for both the implant and autologous phase of reconstruction, demonstrating that patients who underwent autologous reconstruction after failed implant reconstruction experienced significant improvement in satisfaction with their breasts, psychosocial well-being, and physical well-being. 6 However, the degree of satisfaction achieved after failed implant-based reconstruction as compared with a patient with no prior implant reconstruction remains unknown. 8 The aim of this study was to assess how patient satisfaction and decision regret after free-flap breast reconstruction differ between patients with and without a history of prior failed implant reconstruction.…”

“…1 While implant-based reconstruction accounts for approximately 70% of breast reconstruction performed in the United States, 2 3 complications such as chronic pain, capsular contracture, malposition, and infection may result in up to 15 to 20% of patients undergoing a conversion of their implant-based reconstruction to a free-flap reconstructive option. 4 5 6 7 Advances in microsurgical reconstruction have allowed for the increased utilization of perforator flaps for free-flap breast reconstruction, resulting in low rates of donor site morbidity and complications, and sustained long-term satisfaction and well-being. 1 However, the influence of prior implant reconstruction on patient satisfaction and decisional regret after free-flap breast reconstruction has yet to be thoroughly explored.…”

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

“…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.…”