Analysis of complications following implant-based breast reconstruction in breast cancer patients

Background: The complications associated with implant-based breast reconstruction are well recognized. While it is crucial to understand the risk factors associated to specific complications, the existing literature lacks standardized definitions and comprehensive characterization of complications, resulting in significantly heterogenous and non-comparative data. Further in-depth analysis of complications with standardized definition of complications and stratification of risk factors is useful to guide patient selection, support patients to make informed choices, and optimize post-operative care.

Methods: A retrospective study of three surgeons’ experience was performed between 2015 and 2019 at a tertiary hospital. The complications were assessed in accordance with the immediate breast reconstruction and adjuvant therapy audit (iBRA2). Multiple logistic regression analysis was used to determine prognostic impact of different risk factors associated with complications.

Results: A total of 184 patients who underwent breast reconstruction were included. One or more minor and major complications occurred in 75 patients (40.7%). Most common complications were seroma formation requiring aspiration (15.8%), capsular contracture (15.8%), and infection (12.0%). Implant-based breast reconstruction using the latissimus dorsi flap is an important predictor for seroma formation requiring aspiration (OR = 41.27, 95% confidence interval (CI) 11.53–147.66, and p < 0.001). Post-mastectomy radiotherapy shows significant association with capsular contraction (OR = 11.11, 95% CI 3.65–33.8, and p < 0.001). Advancing age was strongly associated with infection related major complications for those aged over 60 years old (OR = 1.04, 95% CI 1.00–1.09, and p < 0.05).

Conclusions: Age, post-mastectomy radiotherapy, and use of the latissimus dorsi flap have a significant prognostic value in complications following implant-based breast reconstruction. Our findings are useful in counseling patients to make informed decisions and also in optimizing post-operative care.