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Analysis of complications following implant-based breast reconstruction in breast cancer patients

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The complications associated with implant-based breast reconstruction are well recognized. While it is crucial to understand the risk factors associated to specific complications, the existing literature lacks standardized definitions and comprehensive characterization of complications, resulting in significantly heterogenous and non-comparative data. Further in-depth analysis of complications with standardized definition of complications and stratification of risk factors is useful to guide patient selection, support patients to make informed choices, and optimize post-operative care.

Methods

A retrospective study of three surgeons’ experience was performed between 2015 and 2019 at a tertiary hospital. The complications were assessed in accordance with the immediate breast reconstruction and adjuvant therapy audit (iBRA2). Multiple logistic regression analysis was used to determine prognostic impact of different risk factors associated with complications.

Results

A total of 184 patients who underwent breast reconstruction were included. One or more minor and major complications occurred in 75 patients (40.7%). Most common complications were seroma formation requiring aspiration (15.8%), capsular contracture (15.8%), and infection (12.0%). Implant-based breast reconstruction using the latissimus dorsi flap is an important predictor for seroma formation requiring aspiration (OR = 41.27, 95% confidence interval (CI) 11.53–147.66, and p < 0.001). Post-mastectomy radiotherapy shows significant association with capsular contraction (OR = 11.11, 95% CI 3.65–33.8, and p < 0.001). Advancing age was strongly associated with infection related major complications for those aged over 60 years old (OR = 1.04, 95% CI 1.00–1.09, and p < 0.05).

Conclusions

Age, post-mastectomy radiotherapy, and use of the latissimus dorsi flap have a significant prognostic value in complications following implant-based breast reconstruction. Our findings are useful in counseling patients to make informed decisions and also in optimizing post-operative care.

Level of evidence: Risk, III, risk/prognostic

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Data Availability

Aggregate data is available upon request.

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Funding

Authors declare that no funds, grants, or other support received for this manuscript.

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Authors and Affiliations

  1. Plastic Surgery Department, Cambridge University Hospital Trust, Addenbrooke’s Hospital, Cambridge, UK

    Meiling MacDonald-Nethercott, Charles M. Malata, Michael S. Irwin, Sarah L. Benyon & Kai Yuen Wong

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  1. Meiling MacDonald-Nethercott
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  2. Charles M. Malata
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  3. Michael S. Irwin
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  4. Sarah L. Benyon
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  5. Kai Yuen Wong
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Contributions

MMN, KYW, and SLB conceived the study. MMN collected the data and performed data analysis. MMN, KYW, and SLB drafted the manuscript. All authors revised and approved the final manuscript. KYW and SLB are senior authors.

Corresponding author

Correspondence to Meiling MacDonald-Nethercott.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Research ethics approval was not required for this study, and this was confirmed using the online Health Research Authority decision tool from Medical Research Council UK (http://www.hra-decisiontools.org.uk/ethics/).

Competing interests

Meiling MacDonald-Nethercott, Charles M. Malata, Michael S. Irwin, Sarah L. Benyon, and Kai Yuen Wong declare no competing interests.

Patient consent

This research involves the use of fully anonymized data that cannot be traced back to individual patients and does not contain any identifying images. Hence, patient consent statement is not included for the study.

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MacDonald-Nethercott, M., Malata, C.M., Irwin, M.S. et al. Analysis of complications following implant-based breast reconstruction in breast cancer patients. Eur J Plast Surg 46, 1059–1068 (2023). https://doi.org/10.1007/s00238-023-02129-2

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