by Asaad, Malke; Slovacek, Cedar; Mitchell, David; Liu, Jun;
Selber, Jesse C.; Clemens, Mark W.; Chu, Carrie K.; Mericli, Alexander F.;
Butler, Charles E.
Plastic and Reconstructive Surgery: June 2022 -
Volume 149 - Issue 6 - p 1080e-1089e
Background:
Implant-based breast reconstruction infections often require
implant explantation. Whereas some plastic surgeons pursue autologous
reconstruction following the first implant-based breast reconstruction failure
caused by infection, others argue that a second attempt is acceptable.
Methods:
The authors conducted a retrospective study of patients who
underwent a second reconstruction attempt with implant-based or free flap
breast reconstruction following explantation because of infection between 2006
and 2019. Surgical and patient-reported outcomes were compared between the two
groups.
Results:
A total of 6093 implant-based breast reconstructions were
performed during the study period, of which 130 breasts met our inclusion
criteria [implant-based, n = 86 (66 percent); free flap, n =
44 (34 percent)]. No significant differences in rates of overall (25 percent
versus 36 percent; p = 0.2) or major (20 percent versus 21
percent; p = 0.95) complications were identified between the free
flap and implant-based cohorts, respectively. Implant-based breast
reconstruction patients were more likely to experience a second infection (27
percent versus 2 percent; p = 0.0007) and reconstruction failure (21
percent versus 5 percent; p = 0.019). Among irradiated patients,
reconstruction failure was reported in 44 percent of the implant-based and 7
percent of the free flap cohorts (p = 0.02). Free flap patients reported
significantly higher scores for Satisfaction with Breasts (73.7 ± 20.1 versus
48.5 ± 27.9; p = 0.0046).
Conclusions:
Following implant-based breast reconstruction explantation
because of infection, implant-based and free flap breast reconstruction had
similar rates of overall and major complications; however, implant-based breast
reconstruction had considerably higher rates of infection and reconstructive
failures and lower patient-reported scores for Satisfaction with Breasts. Given
the high rates of implant-based breast reconstruction failure in patients with
prior radiotherapy and infection-based failure, plastic surgeons should
strongly consider autologous reconstruction in this patient population.
