Risk factors for complications and implant loss after prepectoral implant-based immediate breast reconstruction: medium-term outcomes in a prospective cohort

Abstract

Background Prepectoral implant-based breast reconstruction with acellular dermal matrix has become an increasingly popular option for selected patients. There are no randomized data to demonstrate short- or long-term outcomes. Cohort studies to date have demonstrated safety, but risk factors for complications are unknown. Methods A prospective cohort study of all patients undergoing prepectoral implant-based breast reconstruction between 2013 and 2019. Clinical factors and those related to reconstruction were analysed in relation to complications and implant loss using univariable and multivariable logistic regression. Results A total of 469 reconstructions were undertaken in 289 women; the majority of reconstructions were performed using a one-stage direct-to-implant technique with acellular dermal matrix. Median follow-up was 21 (range 2–71) months. Minor complications were seen after 11·2 per cent of reconstructions, major complications after 5·9 per cent, and the rate of implant loss by 3 months was 3·1 per cent. In the final multivariable model, sentinel node biopsy (odds ratio (OR) 5·06, 95 per cent c.i. 2·00 to 12·80), axillary clearance (OR 6·67, 1·17 to 37·94) and adjuvant radiotherapy (OR 7·11, 1·60 to 31·61) were independent risk factors for development of a major complication, and sentinel node biopsy (OR 4·32, 1·23 to 15·22) for implant loss. Conclusion Prepectoral implant-based breast reconstruction has acceptable medium-term results but careful patient selection is advised.

‘PartBreCon’ study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps

“…The only significant factor associated with a lack of complications was the absence of axillary surgery. This is not an unexpected finding, given the co-morbidities related to the axillary surgery [ 30 ]. However, it was impossible to disengage retrospectively, CWPF with or without axillary surgery for analysis.…”

The Impact of Adjuvant Radiotherapy on Immediate Implant-based Breast Reconstruction Surgical and Satisfaction Outcomes: A Systematic Review and Meta-analysis

“…Finally, 14 studies 11,13–25 were included in this review, and 29 records were excluded. 26–54 The main characteristics and results of the included studies are listed in Tables 1–3. Table 4 gathers the outcomes of the risk of bias assessment according to The Newcastle-Ottawa Scale.…”

Current Global Trends in Prepectoral Breast Reconstruction

“…However, the utilization of acellular dermal matrices (ADMs) has been under consideration even in patients who are at a heightened risk for complications, such as patients undergoing post-mastectomy radiation therapy (PMRT), who are susceptible to the development of capsular contracture [ 32 , 59 , 60 ]. Moreover, in a study conducted by Polotto et al in the year 2023, this retrospective analysis encompassed a sample size of 485 patients, with 439 individuals undergoing ADM-assisted prepectoral breast reconstruction (PPBR).…”