Short-term complications of immediate implant-based breast reconstruction: Risk factor analyses and a novel cumulative risk algorithm.

Abstract

Women undergoing nipple- or skin-sparing mastectomy and immediate implant-based breast reconstruction (IBR) are at risk for developing short-term complications. This patient cohort study aimed to analyze the risk factors associated with complications to guide shared decision-making. Between 2012 and 2019, 1989 IBRs were performed in 1512 women in a single-institution. All IBRs were retrospectively analyzed for complications requiring surgical re-intervention or implant loss within the first 16 postoperative weeks. Furthermore, a cumulative risk algorithm was developed. Short-term complications occurred in 21.3% of all IBRs. Implants were lost in 5.3% of the cases. Smoking was the strongest risk factor with a 2.7- and 2.3-fold increased risk for developing complications and implant loss, respectively. Other factors associated with significantly higher rates of complications were surgery performed by a non-staff oncologic surgeon (OR=1.82), specimen weight >492 g (OR=1.77), implant volume >422 g (OR=1.44), comorbidity (OR=1.43), and procedure time >143 min (OR=1.27). For implant loss, age >44 years was a significant risk factor (OR=1.80). Only smoking, age, implant volume, and comorbidity were implemented in the cumulative risk algorithm. It showed 11% complication and 3% implant loss rate in patients without the indicated risk factors and 50% complications and 17% implant loss if all the risk factors were present. This study showed that although 21% of the breasts required re-intervention for short-term complications, only 5% of the implants were lost. Among other risk factors, smoking was the most important factor associated with complications or implant loss. The developed cumulative risk algorithm can be used to guide informed shared decision-making.