OpenLB
Open Library of Bioscience
Advanced Search
Annals of plastic surgery
06 01, 2022;88 (6): 695-703.

The Failed Breast Implant in Postmastectomy Reconstruction: A Systematic Literature Review of Complications of Implant-Based Breast Reconstruction.

Florian Bucher, Peter M Vogt
Author Information
  1. Florian Bucher: From the Departments of Plastic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany.
PMID: 35102018 DOI: 10.1097/SAP.0000000000002980

Abstract

BACKGROUND: Breast cancer is the most diagnosed malignant neoplasia of female patients worldwide in 2019. Survival has increased making it necessary to offer breast reconstructive procedures to improve quality of life and self-esteem. Implant-based breast reconstruction is the most common approach, making it necessary to quantify the associated complications.
METHODS: A systematic literature review of the PubMed, Cochrane, and Web of Science databases was performed. A total of 9608 citations were identified, and 44 studies met the inclusion criteria.
RESULTS: Studies included reported the incidence of complications either per patient or per breast leading consequently to 2 complication rates depending on the type of reporting. A total of 14.3% of patient-related and 28.8% of breast-related complications while undergoing implant-based reconstruction were reported.Among total complications reported, 72.6% of patient-related and 48.5% of breast-related complications were classified as major complications.A total of 37.6% of patients respectively 15.1% of breasts required prosthesis explantation due to severe complications. Depending on reporting, 9.7% of patients and 4% of breasts required autologous flap reconstruction due to reconstructive failure.
CONCLUSIONS: High complication and failure rates are associated with implant-based breast reconstruction. Lacking randomized controlled trials, the choice between implant-based and autologous breast reconstruction has to be made individually for each patient.

References

  1. Breast Cancer Society. Breast cancer: facts & figures 2019/2020. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf . Accessed February 6, 2021.
  2. Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010–2040. Br J Cancer . 2012;107:1195–1202.
  3. Yoshimura A, Ito H, Nishino Y, et al. Recent improvement in the long-term survival of breast cancer patients by age and stage in Japan. J Epidemiol . 2018;28:420–427.
  4. Ilonzo N, Tsang A, Tsantes S, et al. Breast reconstruction after mastectomy: a ten-year analysis of trends and immediate postoperative outcomes. Breast . 2017;32:7–12.
  5. Petit JY, Rietjens M, Lohsiriwat V, et al. Update on breast reconstruction techniques and indications. World J Surg . 2012;36:1486–1497.
  6. Plastic surgery statistic report. Available at: https://www.plasticsurgery.org/documents/News/Statistics/2019/reconstructive-breast-procedures-age-2019.pdf . Accessed February 6, 2021.
  7. Archangelo SCV, Sabino Neto M, Veiga DF, et al. Sexuality, depression and body image after breast reconstruction. Clinics (Sao Paulo) . 2019;74:e883.
  8. Hirsch EM, Seth AK, Kim JYS, et al. Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction. Plast Reconstr Surg . 2014;134:692e–699e.
  9. Momoh AO, Ahmed R, Kelley BP, et al. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol . 2014;21:118–124.
  10. McCarthy CM, Mehrara BJ, Riedel E, et al. Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg . 2008;121:1886–1892.
  11. Potter S, Chambers A, Govindajulu S, et al. Early complications and implant loss in implant-based breast reconstruction with and without acellular dermal matrix (Tecnoss Protexa®): a comparative study. Eur J Surg Oncol . 2015;41:113–119.
  12. Moher D, Liberati A, Tetzlaff J, et al; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med . 2009;6:e1000097.
  13. Manrique OJ, Charafeddine A, Abu-Ghname A, et al. Two-staged implant-based breast reconstruction: a long-term outcome study in a young population. Medicina (Kaunas) . 2019;55:481.
  14. Fin A, De Biasio F, Mura S, et al. Prepectoral implant-based breast reconstruction using meshed ADM. Plast Surg (Oakv) . 2021;29:81–87.
  15. Safran T, Al-Halabi B, Viezel-Mathieu A, et al. Direct-to-implant, prepectoral breast reconstruction: a single-surgeon experience with 201 consecutive patients. Plast Reconstr Surg . 2020;145:686e–696e.
  16. Lagergren J, Jurell G, Sandelin K, et al. Technical aspects of immediate breast reconstruction with implants: five year follow-up. Scand J Plast Reconstr Surg Hand Surg . 2005;39:147–152.
  17. Ascherman JA, Hanasono MM, Newman MI, et al. Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg . 2006;117:359–365.
  18. Brooks S, Djohan R, Tendulkar R, et al. Risk factors for complications of radiation therapy on tissue expander breast reconstructions. Breast J . 2012;18:28–34.
  19. Cagli B, Barone M, Ippolito E, et al. Ten years experience with breast reconstruction after salvage mastectomy in previously irradiated patients: analysis of outcomes, satisfaction and well-being. Eur Rev Med Pharmacol Sci . 2016;20:4635–4641.
  20. Casella D, Di Taranto G, Marcasciano M, et al. Subcutaneous expanders and synthetic mesh for breast reconstruction: long-term and patient-reported BREAST-Q outcomes of a single-center prospective study. J Plast Reconstr Aesthet Surg . 2019;72:805–812.
  21. Clarke-Pearson EM, Lin AM, Hertl C, et al. Revisions in implant-based breast reconstruction: how does direct-to-implant measure up? Plast Reconstr Surg . 2016;137:1690–1699.
  22. Collier P, Williams J, Edhayan G, et al. The effect of timing of postmastectomy radiation on implant-based breast reconstruction: a retrospective comparison of complication outcomes. Am J Surg . 2014;207:408–411.
  23. Contant CM, van Geel AN, van der Holt B, et al. Morbidity of immediate breast reconstruction (IBR) after mastectomy by a subpectorally placed silicone prosthesis: the adverse effect of radiotherapy. Eur J Surg Oncol . 2000;26:344–350.
  24. Cordeiro PG, Albornoz CR, McCormick B, et al. The impact of postmastectomy radiotherapy on two-stage implant breast reconstruction: an analysis of long-term surgical outcomes, aesthetic results, and satisfaction over 13 years. Plast Reconstr Surg . 2014;134:588–595.
  25. Cowen D, Gross E, Rouannet P, et al. Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications. Breast Cancer Res Treat . 2010;121:627–634.
  26. Delgado JF, García-Guilarte RF, Palazuelo MR, et al. Immediate breast reconstruction with direct, anatomic, gel-cohesive, extra-projection prosthesis: 400 cases. Plast Reconstr Surg . 2010;125:1599–1605.
  27. Dicuonzo S, Leonardi MC, Radice D, et al. Long-term results and reconstruction failure in patients receiving postmastectomy radiation therapy with a temporary expander or permanent implant in place. Plast Reconstr Surg . 2020;145:317–327.
  28. Dikmans RE, Negenborn VL, Bouman MB, et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol . 2017;18:251–258.
  29. Drucker-Zertuche M, Bargallo-Rocha E, Zamora-Del RR. Radiotherapy and immediate expander/implant breast reconstruction: should reconstruction be delayed? Breast J . 2011;17:365–370.
  30. Elswick SM, Harless CA, Bishop SN, et al. Prepectoral implant-based breast reconstruction with postmastectomy radiation therapy. Plast Reconstr Surg . 2018;142:1–12.
  31. Gdalevitch P, Ho A, Genoway K, et al. Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: predictors of failure. Plast Reconstr Surg . 2014;133:738e–747e.
  32. Headon H, Kasem A, Manson A, et al. Clinical outcome and patient satisfaction with the use of bovine-derived acellular dermal matrix (SurgiMend™) in implant based immediate reconstruction following skin sparing mastectomy: a prospective observational study in a single centre. Surg Oncol . 2016;25:104–110.
  33. Hirsch EM, Seth AK, Dumanian GA, et al. Outcomes of immediate tissue expander breast reconstruction followed by reconstruction of choice in the setting of postmastectomy radiation therapy. Ann Plast Surg . 2014;72:274–278.
  34. Ho AL, Bovill ES, Macadam SA, et al. Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction: a University of British Columbia perspective. Plast Reconstr Surg . 2014;134:1e–10e.
  35. Jiménez-Puente A, Prieto-Lara E, Rueda-Domínguez A, et al. Complications in immediate breast reconstruction after mastectomy. Int J Technol Assess Health Care . 2011;27:298–304.
  36. Kobraei EM, Nimtz J, Wong L, et al. Risk factors for adverse outcome following skin-sparing mastectomy and immediate prosthetic reconstruction. Plast Reconstr Surg . 2012;129:234E–241E.
  37. Krueger EA, Wilkins EG, Strawderman M, et al. Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys . 2001;49:713–721.
  38. Lam TC, Borotkanics R, Hsieh F, et al. Immediate two-stage prosthetic breast reconstruction failure: radiation is not the only culprit. Plast Reconstr Surg . 2018;141:1315–1324.
  39. Lee JS, Kim JS, Lee JH, et al. Prepectoral breast reconstruction with complete implant coverage using double-crossed acellular dermal matrixs. Gland Surg . 2019;8:748–757.
  40. Lee KT, Bae J, Jeon BJ, et al. Adjuvant chemotherapy in two-stage tissue expander/implant breast reconstruction: does it affect final outcomes? Ann Surg Oncol . 2021;28:2191–2198.
  41. Li FC, Jiang HC, Li J. Immediate breast reconstruction with implants after skin-sparing mastectomy: a report of 96 cases. Aesthetic Plast Surg . 2010;34:705–710.
  42. Lin KY, Blechman AB, Brenin DR. Implant-based, two-stage breast reconstruction in the setting of radiation injury: an outcome study. Plast Reconstr Surg . 2012;129:817–823.
  43. Manrique OJ, Kapoor T, Banuelos J, et al. Single-stage direct-to-implant breast reconstruction a comparison between subpectoral versus prepectoral implant placement. Ann Plast Surg . 2020;84:361–365.
  44. Mousa M, Barnea Y, Arad U, et al. Association between postoperative complications after immediate alloplastic breast reconstruction and oncologic outcome. Clin Breast Cancer . 2018;18:e699–e702.
  45. Nealon KP, Weitzman RE, Sobti N, et al. Prepectoral direct-to-implant breast reconstruction: safety outcome endpoints and delineation of risk factors. Plast Reconstr Surg . 2020;145:898e–908e.
  46. Olinger TA, Berlin NL, Qi J, et al. Outcomes of immediate implant-based mastectomy reconstruction in women with previous breast radiotherapy. Plast Reconstr Surg . 2020;145:1029e–1036e.
  47. Reish RG, Lin A, Phillips NA, et al. Breast reconstruction outcomes after nipple-sparing mastectomy and radiation therapy. Plast Reconstr Surg . 2015;135:959–966.
  48. Reitsamer R, Peintinger F, Klaassen-Federspiel F, et al. Prepectoral direct-to-implant breast reconstruction with complete ADM or synthetic mesh coverage—36-months follow-up in 200 reconstructed breasts. Breast . 2019;48:32–37.
  49. Riggio E, Toffoli E, Tartaglione C, et al. Local safety of immediate reconstruction during primary treatment of breast cancer. Direct-to-implant versus expander-based surgery. J Plast Reconstr Aesthet Surg . 2019;72:232–242.
  50. Roostaeian J, Pavone L, Da Lio A, et al. Immediate placement of implants in breast reconstruction: patient selection and outcomes. Plast Reconstr Surg . 2011;127:1407–1416.
  51. Roostaeian J, Sanchez I, Vardanian A, et al. Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction. Plast Reconstr Surg . 2012;129:909e–918e.
  52. Seth AK, Hirsch EM, Fine NA, et al. Utility of acellular dermis-assisted breast reconstruction in the setting of radiation: a comparative analysis. Plast Reconstr Surg . 2012;130:750–758.
  53. Srinivasa DR, Garvey PB, Qi J, et al. Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg . 2017;140:869–877.
  54. Tallet AV, Salem N, Moutardier V, et al. Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results. Int J Radiat Oncol Biol Phys . 2003;57:136–142.
  55. Woerdeman LA, Hage JJ, Smeulders MJ, et al. Skin-sparing mastectomy and immediate breast reconstruction by use of implants: an assessment of risk factors for complications and cancer control in 120 patients. Plast Reconstr Surg . 2006;118:321–330.
  56. Yoon AP, Qi J, Kim HM, et al. Patient-reported outcomes after irradiation of tissue expander versus permanent implant in breast reconstruction: a multicenter prospective study. Plast Reconstr Surg . 2020;145:917e–926e.
  57. Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg . 2013;131:15–23.
  58. Cemal Y, Albornoz CR, Disa JJ, et al. A paradigm shift in U.S. breast reconstruction: part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg . 2013;131:320e–326e.
  59. Sando IC, Billig JI, Ambani SW, et al. An evaluation of the choice for contralateral prophylactic mastectomy and patient concerns about recurrence in a reconstructed cohort. Ann Plast Surg . 2018;80:333–338.
  60. Jerome-D'Emilia B, Suplee PD, Boiler JL, et al. A woman's decision to choose bilateral mastectomy. Cancer Nurs . 2015;38:426–435.
  61. Heidemann LN, Gunnarsson GL, Salzberg CA, et al. Complications following nipple-sparing mastectomy and immediate acellular dermal matrix implant-based breast reconstruction—a systematic review and meta-analysis. Plast Reconstr Surg Glob Open . 2018;6:e1625.
  62. Corkum JP, Butler K, Zhong T. Higher distress in patients with breast cancer is associated with declining breast reconstruction. Plast Reconstr Surg Glob Open . 2020;8:e2636.
  63. Fanakidou I, Zyga S, Alikari V, et al. Mental health, loneliness, and illness perception outcomes in quality of life among young breast cancer patients after mastectomy: the role of breast reconstruction. Qual Life Res . 2018;27:539–543.
  64. Gerber B, Marx M, Untch M, et al. Breast reconstruction following cancer treatment [published correction appears in Dtsch Arztebl Int . 2016 22;113:286]. Dtsch Arztebl Int . 2015;112:593–600.
  65. Covelli AM, Baxter NN, Fitch MI, et al. Increasing mastectomy rates-the effect of environmental factors on the choice for mastectomy: a comparative analysis between Canada and the United States. Ann Surg Oncol . 2014;21:3173–3184.
  66. Albornoz CR, Cordeiro PG, Hishon L, et al. A nationwide analysis of the relationship between hospital volume and outcome for autologous breast reconstruction. Plast Reconstr Surg . 2013;132:192e–200e.
  67. Gurunluoglu R, Gurunluoglu A, Williams SA, et al. Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg . 2013;70:103–110.
  68. Panchal H, Matros E. Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg . 2017;140(5S Advances in Breast Reconstruction):7S–13S.
  69. MDS. Brustimplantate. Available at: https://www.yumpu.com/de/document/read/10893351/implantate-katalog-brustimplantate-mds . Accessed February 20, 2021.
  70. Toyserkani NM, Jørgensen MG, Tabatabaeifar S, et al. Autologous versus implant-based breast reconstruction: a systematic review and meta-analysis of Breast-Q patient-reported outcomes. J Plast Reconstr Aesthet Surg . 2020;73:278–285.
  71. Jagsi R, Momoh AO, Qi J, et al. Impact of radiotherapy on complications and patient-reported outcomes after breast reconstruction. J Natl Cancer Inst . 2018;110:157–165.
  72. Hangge PT, Jogerst K, Mohsen A, et al. Making an informed choice: which breast reconstruction type has the lowest complication rate? Am J Surg . 2019;218:1040–1045.

MeSH Term

Breast Implantation
Breast Implants
Breast Neoplasms
Female
Humans
Mammaplasty
Mastectomy
Postoperative Complications
Quality of Life
Retrospective Studies
Journal Article Systematic Review

Word Cloud

Created with Highcharts 10.0.0complicationsbreastreconstructiontotalBreastpatientsreportedimplant-basedmakingnecessaryreconstructiveassociatedperpatientcomplicationratesreportingpatient-relatedbreast-related6%breastsrequireddueautologousfailureBACKGROUND:cancerdiagnosedmalignantneoplasiafemaleworldwide2019Survivalincreasedofferproceduresimprovequalitylifeself-esteemImplant-basedcommonapproachquantifyMETHODS:systematicliteraturereviewPubMedCochraneWebSciencedatabasesperformed9608citationsidentified44studiesmetinclusioncriteriaRESULTS:Studiesincludedincidenceeitherleadingconsequently2dependingtype143%288%undergoingAmong72485%classifiedmajorA37respectively151%prosthesisexplantationsevereDepending97%4%flapCONCLUSIONS:HighLackingrandomizedcontrolledtrialschoicemadeindividuallyFailedImplantPostmastectomyReconstruction:SystematicLiteratureReviewComplicationsImplant-BasedReconstruction

Similar Articles

Cited By (3)