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

Frisell, A; Lagergren, Jesper; Halle, Martin; Boniface, Jana de

doi:10.1007/s10549-020-05911-z

Cited by 14 publications

(5 citation statements)

References 14 publications

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“…After screening for titles and abstracts, and reviewing full-text articles, 33 studies were short-listed. 4,9,10,12–15,20–45 The Preferred Reporting Items for Systematic review and Meta-Analyses flowchart summarizes the results of our literature search. ( See figure, Supplemental Digital Content 2 , which displays the Preferred Reporting Items for Systematic review and Meta-Analyses flowchart.…”

Section: Resultsmentioning

confidence: 99%

Predictors of Complications after Breast Reconstruction Surgery: A Systematic Review and Meta-analysis

Mrad

Qurashi

Mardan³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Breast reconstruction (BR) is a unique surgical procedure that provides patients undergoing mastectomy with significant psychosocial and aesthetic benefits and has also become a crucial part of the treatment pathway for women with breast cancer. Due to methodological inadequacies and the absence of substantial risk factor analysis, no conclusion can be drawn about the correlation between risk variables and post-surgical complications in BR surgery. We aim to identify the potential risk factors associated with postoperative complications. Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to March 2022, for published randomized controlled trials and observational studies that assessed complications post-reconstruction procedure in breast cancer patients following mastectomy or evaluated at least one of the following outcomes of major or reoperative complications. The results from the studies were presented as odds ratios with 95% confidence intervals and were pooled using a randomeffects model. Results: Our pooled analysis demonstrated a significant correlation with BR postoperative complications and risk factors such as diabetes, hypertension, and obesity. Diabetes and the development of seroma were found to have a significant relationship. Risk variables such as age, radiotherapy, COPD, and smoking had no significant connection with 0-to-30-day readmission and 30-to-90-day readmission. Conclusion:This meta-analysis shows that risk factors like age, smoking history, high blood pressure, and body mass index (BMI) have a big effect on complications after BR, and patients with risk factors have a high rate of developing infection.

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Section: Resultsmentioning

confidence: 99%

Predictors of Complications after Breast Reconstruction Surgery: A Systematic Review and Meta-analysis

Mrad

Qurashi

Mardan³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…The information that the ultrasound provides is probably even more important in breast reconstruction patients, where the secondary surgical procedure is associated with higher risk of implant-related complication. 42 In our experience, ultrasound screening for breast implant complications does not require a radiologist´s interpretation; it just requires basic familiarity with ultrasound concepts, sufficient hands-on training on the part of the surgeon or the staff, and repetitive clinical use.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Breast Implant Assessment Using Ultrasound: A Case Series from the International Breast Implant Check Clinic

Jaeger,

Randquist,

Gahm

2023

Plastic and Reconstructive Surgery - Global Open

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Background: Breast augmentation with anatomic implants can achieve a natural look, but over time, implant-related complications can occur. This includes a risk of potential rotation, which can cause a change in breast shape. Reported rates of rotation vary widely (0%–42%). Implant rotation is often detected by physical examination only or as a perioperative finding. Change in breast shape after augmentation requires clinical evaluation. In-office ultrasound allows for detailed assessment of implants for rotation and other complications. Methods: Women with anatomical breast implants seeking follow-up at the International Breast Implant Check Clinic in Stockholm, Sweden, from April 2020 to July 2022 were included in the study. Using a standardized protocol, subjective symptoms were recorded, and a physical examination followed by an ultrasound assessment was performed by a single board-certified plastic surgeon (M.J.) trained in implant assessment via ultrasound. Rotation was defined as an implant rotated past 30 degrees off the breast midline at 6 o’clock. Results: The study included 308 women (mean age 40.1, range 20-78) with bilateral anatomical implants. Overall, 40 women (13.0%) reported a change in breast shape; 35 had one or more implant-related complications, including five with rotation on ultrasound. Of the 308 women, 11 (3.6%) had rotations upon physical examination, and an additional 10 cases were identified using ultrasound. Conclusions: Rotation is a potential complication of anatomical breast implants. However, in this study, change in breast shape was more commonly caused by other implant-related complications. Ultrasound is a valuable tool in evaluating causes of change in breast shape.

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“…As confirmed in the present analysis, a major problem with implant-based IBR in the context of RT is that long-term effects such as capsular contracture will continue to generate the need for revisional surgery and/or conversion to autologous reconstruction even after many years. Revisional surgery poses a significant risk of implant loss owing to postoperative complications and so the risk of reconstructive failure is never eliminated 12 . Autologous reconstruction, on the other hand, tends to come with a higher risk of postoperative complications but far fewer negative long-term consequences and less need for revisional surgery 19 , 20 .…”

Section: Discussionmentioning

confidence: 99%

“…The existing literature on breast reconstruction in the face of PMRT is compromised by substantial heterogeneity in reconstructive methods and timing, limited population sizes, and/or limited follow-up. Implant-based as opposed to autologous breast reconstruction is prone to repeated revisional operations, which contributes to an increased cumulative risk of postoperative complications and, ultimately, failure of reconstruction, especially in the context of PMRT 12 . It is, therefore, very important to assess long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of implant-based immediate breast reconstruction with and without radiotherapy: a population-based study

Boniface

Adam

Frisell

et al. 2022

British Journal of Surgery

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Background Radiotherapy (RT) is a risk factor for impaired outcomes after implant-based immediate breast reconstruction (IBR). Large studies including long-term follow-up are relatively scarce. The purpose of this analysis was to assess long-term effects of RT in implant-based IBR, distinguishing between implant removal because of postoperative complications versus patient preference. Methods This population-based cohort study included all patients with breast cancer who underwent implant-based IBR in Stockholm between 2005 and 2015. Data were collected through national registers and medical charts. The main endpoint was implant removal owing to postoperative complications (wound breakdown, infection, bleeding) or patient preference (dissatisfaction, pain, capsular contracture), with or without conversion to autologous reconstruction. Results Some 1749 implant-based IBRs in 1687 women were included. Median follow-up was 72 (range 1–198) months. Reconstructions were divided according to receipt of RT: No RT (n = 856, 48.9 per cent), adjuvant RT (n = 749, 42.8 per cent), and previous RT (n = 144, 8.2 per cent). Implant removal occurred after 266 reconstructions (15.2 per cent); 68 (7.9 per cent) in the no RT, 158 (21.1 per cent) in the adjuvant RT, and 40 (27.8 per cent) in the previous RT group. Implant removal was because of postoperative complications in 152 instances (57.1 per cent) and was most common in the first 3 years. This was especially observed in the previous RT group, where 15 of 23 implant removals occurred during the first 6 months. Implant removal owing to patient preference (114 of 266, 42.9 per cent) became more common with increasing follow-up. Conclusion Implant removal after implant-based IBR is significantly associated with RT. The reason for implant removal shifts over time from postoperative complications to patient preference.

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

Cited by 14 publications

References 14 publications

Predictors of Complications after Breast Reconstruction Surgery: A Systematic Review and Meta-analysis

Predictors of Complications after Breast Reconstruction Surgery: A Systematic Review and Meta-analysis

Anatomical Breast Implant Assessment Using Ultrasound: A Case Series from the International Breast Implant Check Clinic

Long-term outcomes of implant-based immediate breast reconstruction with and without radiotherapy: a population-based study

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