Tissue Expander Complications Do Not Preclude a Second Successful Implant-Based Breast Reconstruction

Abstract

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 (TE) complication are rarely studied. The purpose of this study is to determine the long term incidence of implant loss in patents with a previous TE complication. Methods: This is a retrospective review of the long term outcomes of all patients with TE complications at a large academic medical center from 2003–2013. Patients with subsequent TE 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 was 8.3 ± 3.1 years. Forty-eight women (30%) went on to have a second TE or implant placed. They did not differ from women who went on to autologous reconstruction or no further reconstruction. Of these, 34 women (71%) had no further complications, and 38 women (79%) 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 TE 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.

Reconstructive Trends After Tissue-Expander Loss in Breast Reconstruction

“…Given the occurrence of complication after initial expander placement, it is important for surgeons and patients to consider the options available for a safe continuation of reconstruction. In the instance of implant infection, the reported cause of the majority of implant failure in previously published work and our data, 8,10 the decision between medical management, reoperation with implant salvage, or implant removal must be made.…”

“…Of the 56 patients in the study's patient cohort who underwent explantation of the implant, the majority underwent a secondary implant-based reconstruction successfully. A recent study by Poppler et al 10 further demonstrated the safety of a secondary implant-based reconstruction after initial tissueexpander failure, with 79% of their patient cohort having successful reconstruction at the time of final follow-up despite earlier explantation. In our patient cohort, 674 patients were initially screened, and the 60 patients who underwent tissue-expander explantation were included.…”

Experiences of implant loss after immediate implant-based breast reconstruction: qualitative study

“…Implant loss is likely to become a major problem worldwide as rates of implant‐based breast reconstruction continue to increase. The growing magnitude of the problem is reflected in the numbers of recent studies reporting the clinical outcomes of autologous or further implant‐based reconstruction performed after a failed implant‐based procedure. Although the technical success rates of further reconstructive surgery are high, few studies have included patient‐reported outcomes (PROs) in their assessment of success.…”

Plastic Surgery in the Time of COVID-19

“…Since time to postoperative complications requiring in-patient admission for intravenous antibiotics or operative removal is generally within 60 days of reconstruction, the risk of hardware exposure in this acute time period may be worth mitigating with a subpectoral technique. 29 Even though recent data demonstrate no significant difference in postoperative complication and infection rate, it may be prudent for plastic surgeons less familiar with prepectoral placement or encountering any concern regarding mastectomy skin flap thickness to utilize the subpectoral technique. [30][31][32] The greater postoperative pain involved with the subpectoral technique may be treated with pectoral type-2 (PECS II) nerve blocks or paravertebral blocks to allow for same day discharge.…”