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Introduction
For patients undergoing prosthetic breast reconstruction whose device was removed due to infection or exposure, there is no published information examining long-term outcomes. Despite initial failure, many patients wish to pursue breast reconstruction. It would be helpful to know whether second attempts at reconstruction can be successful, which factors influence secondary reconstructive choices and which factors are associated with eventual success.
Methods
A retrospective review was performed of immediate prosthetic breast reconstruction failures performed by two senior surgeons over a 5-year period. Failure was defined as any device removed for an extended time period for infection or exposure.
Results
29 breasts in 26 patients were identified who failed primary prosthetic 2-stage reconstruction. On average, the device was removed 262 days from initial expander placement. 19 were removed for infection, 7 for exposure, and 3 for a combination of both. Of these 29 failures, secondary reconstruction was attempted in 20(69%). Among secondary reconstructions, 13 were with a device and 7 with autologous tissue. Only 1(7.7%) of the secondary device reconstructions subsequently failed and was removed, with the remaining 12(92.3%) successful at an average 596 days from secondary reconstruction.
Those in whom secondary reconstruction was attempted were younger at initial reconstruction (48 vs 57 years; p=0.038), had lower BMI’s (26.0 vs 29.4; p=0.27), and smaller breasts (650 vs 979 gms; p=0.23) than those that didn’t attempt secondary reconstruction.
100% of nipple-sparing mastectomy patients underwent secondary reconstruction, while only 61% of skin-sparing mastectomy patients underwent secondary reconstruction (p=0.14).
For patients undergoing secondary reconstruction, those receiving a second device reconstruction had lower BMI’s(24.7 vs 28.5; p=0.18) and smaller breasts (489 vs 946 gms; p=0.08) than those with autologous reconstructions. 15 percent of the secondary implant reconstructions underwent irradiation versus 43 percent of the secondary autologous reconstructions(p=0.29).
Discussion
In this series of patients who failed primary prosthetic breast reconstruction, two-thirds went on to successful secondary reconstruction. Smaller BMI, smaller breast size, younger age and retaining the nipple were associated with attempting secondary reconstruction.
Patients that underwent irradiation, had larger breasts, and higher BMI’s were more likely to undergo autologous reconstruction than a second implant reconstruction.
After failed prosthetic breast reconstruction, a second attempt with a new implant in properly selected patients has high success rates (92.3%).