by Poppler, Louis H.;
Mundschenk, Minh-Bao; Linkugel, Andrew; Zubovic, Ema; Dolen, Utku C.; Myckatyn,
Terence M.
Background:
Implant-based breast reconstruction is the most common method of breast
reconstruction in the United States, but the outcomes of subsequent implant-based
reconstruction after a tissue expander complication are rarely studied. The
purpose of this study was to determine the long-term incidence of implant loss
in patents with a previous tissue expander complication. Methods: This is a retrospective review of the long-term outcomes
of all patients with tissue expander complications at a large academic medical
center from 2003 to 2013. Patients with subsequent tissue expander or implant
complications were compared to those with no further complications to assess
risk factors for additional complications or reconstructive failure.
Results: One
hundred sixty-two women were included in this study. The mean follow-up period
was 8.3 ± 3.1 years. Forty-eight women (30 percent) went on to undergo a second
tissue expander or implant placement. They did not differ from women who went
on to autologous reconstruction or no further reconstruction. Of these, 34
women (71 percent) had no further complications and 38 women (79 percent) had a
successful implant-based reconstruction at final follow-up. There were no
patient or surgical factors significantly associated with a second complication
or implant loss.
Conclusions:
Following tissue expander complications, it is reasonable to offer women a
second attempt at tissue expansion and implant placement. This study
demonstrates that long-term success rates are high, and there are no definitive
patient or surgical factors that preclude a second attempt at implant-based
breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
