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BACKGROUND: Nipple- or skin-sparing mastectomy and immediate implant-based breast reconstruction (IBR) is potentially associated with long-term unfavorable outcomes such as revision surgery and reconstruction failure. This large patient cohort study aimed to provide long-term data on the incidence of these outcomes and identify predictive risk factors. METHODS: Between 2012 and 2019 1,989 mastectomies with IBR were performed in 1,512 women in our institute. A direct-to-implant (DTI) method was used in 93% and a two-staged method with tissue-expander in 7%. Logistic regression analysis was used to identify patient- and treatment-related risk factors associated with revision surgery or reconstructive failure. RESULTS: Mean follow-up was 62.2 months. IBR failed in 6.7% of all breasts, thus a breast was present in 93.3%. Age older than 44 years old yielded a 2.6- and radiotherapy a 1.7-fold increased risk for reconstruction failure. Revision surgery was performed in 60% of all breasts. Mean number of revisions of all IBRs is 1.2 (range, 0-8; SD 1.37). Factors associated with significant higher rates of revision surgeries were age>44 years (OR=1.23), smoking (OR=1.53), specimen weight>492 grams (OR=1.39), implant volume>422 grams (OR=1.95) and radiotherapy (OR=1.51). Nipple preservation was protective for both outcomes (OR=0.71 and OR=0.42, respectively). DTI did not require any surgical revision in 43%. CONCLUSION: Despite the necessity of revision surgery in the majority of IBRs, nearly half of the breasts did not require any revision surgery, and long-term reconstruction failure rates are extremely low. Therefore, IBR should be offered to all eligible women undergoing mastectomy while understanding the risks.
Kooijman et al. (Tue,) studied this question.
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