The Failed Breast Implant in Postmastectomy Reconstruction

Abstract

BackgroundBreast cancer is the most diagnosed malignant neoplasia of female patients worldwide in 2019. Survival has increased making it necessary to offer breast reconstructive procedures to improve quality of life and self-esteem. Implant-based breast reconstruction is the most common approach, making it necessary to quantify the associated complications.MethodsA systematic literature review of the PubMed, Cochrane, and Web of Science databases was performed. A total of 9608 citations were identified, and 44 studies met the inclusion criteria.ResultsStudies included reported the incidence of complications either per patient or per breast leading consequently to 2 complication rates depending on the type of reporting. A total of 14.3% of patient-related and 28.8% of breast-related complications while undergoing implant-based reconstruction were reported.Among total complications reported, 72.6% of patient-related and 48.5% of breast-related complications were classified as major complications.A total of 37.6% of patients respectively 15.1% of breasts required prosthesis explantation due to severe complications. Depending on reporting, 9.7% of patients and 4% of breasts required autologous flap reconstruction due to reconstructive failure.ConclusionsHigh complication and failure rates are associated with implant-based breast reconstruction. Lacking randomized controlled trials, the choice between implant-based and autologous breast reconstruction has to be made individually for each patient.

Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review

“…Some high-risk devices, such as breast implants or pelvic mesh, have been recognized to have complications that may occur many years after insertion, such as breast-implant-associated anaplastic large cell lymphoma or chronic pain resulting from pelvic mesh breakdown. 6 , 106 , 107 Thus, further research needs to be undertaken into the feasibility and sensitivity of long-term device monitoring with PROMs in these circumstances.…”

Breast Cancer Local Recurrence Risk in Implant-Based Breast Reconstruction with Macrotexturized and Microtexturized Prosthesis: A Multicentric Retrospective Cohort Study

“…11 The two-stage implant-based approach, in which an initial surgery is required for expander placement, is actually the most commonly performed. 10 Expander employments provide optimal outcomes, although contralateral mastoplasty is often needed to improve symmetry. 12 Breast prosthesis may be categorized into smooth and texturized implants according to prosthesis surface; the latter subdivided into microtexturized and macrotexturized.…”

“…9 Currently, implant-based BR is the prevailing method adopted by plastic surgeons. 10 Implant-based BR can be achieved with prosthesis placement in the submuscular or prepectoral plane and scheduled as an one- or two-stage procedure according to patient's characteristics. 11 The two-stage implant-based approach, in which an initial surgery is required for expander placement, is actually the most commonly performed.…”

“…11 The two-stage implant-based approach, in which an initial surgery is required for expander placement, is actually the most commonly performed. 10 Expander employments provide optimal outcomes, although contralateral mastoplasty is often needed to improve symmetry. 12…”

Free Tissue Transfer for Reconstruction After Bilateral Skin Sparing Mastectomy—A Systematic Review

“…5 After mastectomy, breast reconstruction can be performed by using implants, skin expanders, pedicled tissue or free vascularized autologous tissue, or secondary autologous lipotransfer. 6 Although it is preferred by patients, implant-based breast reconstruction is associated with complications rates in up to 70% of cases, leading to subsequent reoperations, 7 while autologous free tissue transfer is intended to provide significantly lower reoperation rates with a consequently higher sustainability. The aim of this systematic literature review is to investigate the better outcome and sustainability of bilateral breast reconstruction using autologous, vascularized free tissue transfer.…”