The clinical course of immediate breast implant reconstruction after breast cancer

Abstract

Background. The number of women suitable for breast conserving treatment as well as immediate reconstruction after breast cancer has been increasing, and studies of complications hereafter are needed. Material and methods. The cohort was identified in the prospective database of the Danish Registry for Plastic Surgery of the Breast during the period 1999 to 2006; 167 women with 189 immediate breast reconstructions (40 one-stage and 149 two-stage procedures) after breast cancer without a history of radiation therapy. The women were followed for complications until November 2009. Cumulative incidence risks were computed for infection, hematoma, seroma, severe capsular contracture (modified Baker III and IV), extrusion of the implant, implant rupture, asymmetry/displacement of the implant, any complication, and reoperation. In addition, we compared the postoperative course of immediate two-stage procedures with delayed two-stage procedures. Results. The overall eight-year risk estimates for the immediate procedures were 76.4% for any complication, 5.3% for severe capsular contracture, 29.5% for displacement/asymmetry of the implant and 40.6% for reoperation. Significantly higher risk for reoperation was observed after immediate one-stage than after two-stage procedures. For immediate two-stage procedures acute complications such as infection, seroma and hematoma were higher in the expansion period than after the second planned surgery. Higher risks for acute complications were observed after immediate than after delayed two-stage procedures. Conclusion. Immediate breast implant reconstruction was found to have substantial risks of complications in non-radiated women, which should be considered in the guidance of breast cancer patients before choosing reconstructive procedure.

Acknowledgements

The authors want to thank Randi Karlsen, project nurse at the DPB for invaluable and dedicated work. We are very grateful to all the surgeons and clinic staff at the public and private clinics who contribute to the continuously central registration. We also want to thank all the participating women for allowing the use of their data and for taking the time to fill in the questionnaires. The Danish Registry for Plastic Surgery of the Breast is partly funded by Mentor Corp, Santa Barbara, USA, and was partly funded by International Epidemiology Institute, Rockville, Maryland, USA, which in turn received funding from Allergan, Inc. up until the end of 2009. Neither Mentor Corp. nor Allergan, Inc. was involved in any aspect of the study design, data collection, data analysis, data interpretation, writing or review of the manuscript. None of the authors have any conflicts of interest regarding the present study. Dr. McLaughlin has served as a consultant to the Inamed Corporation (now part of Allergan, Inc.) during their application to the FDA for premarket approval of silicone implants.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.