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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Reducing implant loss rates in immediate breast reconstructions
L Darragh1, A Robb2, C M Hardie3
1Departments of General Surgery, The Newcastle Breast Centre, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
Breast (Edinburgh, Scotland)
|December 4, 2016
Summary
UK breast reconstruction guidelines improved outcomes, reducing implant loss rates significantly. However, this success was linked to an aggressive salvage policy, raising questions about current quality indicator standards for return to theatre rates.
Area of Science:
- Oncoplastic surgery
- Breast reconstruction outcomes
- Surgical quality improvement
Background:
- UK best practice guidelines for oncoplastic breast reconstruction were published in 2012.
- Quality indicator (QI) targets for implant-based reconstruction were set at 5% for readmission, return to theatre, and implant loss rates by 3 months.
Purpose of the Study:
- To quantify complication rates following implant-based reconstruction before and after guideline implementation.
- To evaluate the impact of institutional changes, including reduced antibiotic usage, on reconstruction outcomes.
Main Methods:
- Retrospective audit (C1: 86 patients, 106 implants, pre-guideline changes).
- Prospective audit (C2: 89 patients, 105 implants, post-guideline changes).
- Extended follow-up of salvaged implants.
Main Results:
- Implant loss rates decreased from 7.5% (C1) to 1.9% (C2) (p=0.054).
- Return to theatre rates increased from 14.2% to 18% (p>0.05).
- Implant salvage rate increased from 47% (C1) to 89.5% (C2), with an overall long-term salvage rate of 82.4% in C2.
Conclusions:
- An implant loss rate below 5% is achievable with reduced antibiotic use.
- Achieving low implant loss required an aggressive readmission and salvage policy.
- Current QI standards for readmission and return to theatre may need re-evaluation for immediate implant-based breast reconstruction.
