AI Article Synopsis
- - The study investigates outcomes of second implant-based breast reconstructions after infections led to the removal of the first devices, analyzing data from over 6,000 surgeries between 2006 and 2019.
- - Out of 298 infected cases, 83 patients received 92 second implants, with a notable 36% experiencing postoperative complications, primarily infections (25%), and significantly higher infection rates for second attempts compared to first attempts.
- - Despite a high overall success rate of 88% for cases without prior radiation or device exchange, patient satisfaction regarding breast appearance and sexual well-being was lower for second attempts, highlighting the risks and the need for realistic expectations for patients considering repeat surgeries.
Article Abstract
Background: Infection is a dreaded complication of implant-based breast reconstruction. There is a paucity of literature on the outcomes of a secondary reconstruction after infected implant-based breast reconstruction explantation.
Methods: The authors conducted a retrospective study of patients who underwent a second implant-based breast reconstruction following a failed infected device between January of 2006 and December of 2019. Surgical and patient-reported outcomes (BREAST-Q) were collected and analyzed.
Results: A total of 6093 implant-based breast reconstructions were performed during the study period, 298 (5 percent) of which involved device removal because of infection. Eighty-three patients ultimately received 92 second-attempt breast implants. Thirty-six percent of cases developed at least one postoperative complication, with infection [23 breasts (25 percent)] being the most common. Compared with first-attempt implant-based breast reconstruction, we found significantly higher infection rates among second-attempt cases (9 percent and 21 percent, respectively; p = 0.0008). Patient-reported satisfaction with the breast and sexual well-being were lower after second-attempt than after first-attempt implant-based breast reconstruction ( p = 0.018 and p = 0.002, respectively) reported in the literature. Mean follow-up was 41 ± 35 months. If we exclude patients with prior radiation therapy and those who received device exchange, the success rate is 88 percent.
Conclusions: It is reasonable to offer women second-attempt implant-based breast reconstruction after explantation because of infection. However, this patient population has a higher infection and explantation rate and lower patient-reported satisfaction than patients undergoing first-attempt implant-based breast reconstruction. Because of these increased surgical risks and elevated complication rates, patients must be given reasonable expectations during preoperative discussions and when providing informed consent for second-attempt implant-based breast reconstruction.
Clinical Question/level Of Evidence: Risk, III.
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| http://dx.doi.org/10.1097/PRS.0000000000009289 | DOI Listing |
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