Bilateral Risk-Reducing Mastectomies with Implant-Based Reconstructions Followed Long Term: A Consecutive Series of...

Area of Science:

• Oncology
• Plastic Surgery
• Medical Device Technology

Background:

• Bilateral risk-reducing mastectomy (BRRM) is a key breast cancer prevention strategy for genetically predisposed individuals.
• Immediate breast reconstruction with implants is frequently performed concurrently with BRRM, but outcomes can vary.
• Reconstruction timelines and the need for corrective surgeries are significant considerations in BRRM.

Purpose of the Study:

• To evaluate surgical outcomes and resource consumption in 185 patients undergoing BRRM with immediate implant-based breast reconstruction.
• To compare the long-term efficacy of permanent expander implants (PEIs) versus permanent fixed volume implants (PIs) in this patient cohort.
• To identify factors influencing early complications and reoperation rates following implant-based breast reconstruction post-BRRM.

Main Methods:

• A retrospective analysis of 185 consecutive cases of BRRM with immediate implant reconstruction over an 18-year period.
• Comparison of outcomes between patients receiving PEIs (n=138) and PIs (n=47), with a minimum 2-year follow-up.
• Multivariate analysis to assess the impact of patient demographics (age, BMI), smoking status, implant type, and surgical factors on complications.

Main Results:

• Higher BMI (≥25) was significantly associated with an increased risk of early complications (OR 7.1).
• Median reconstruction time was substantially longer for PEIs (12.4 months) compared to PIs (1.0 month) (p<0.001).
• The 2-year reoperation-free survival rate was significantly higher for PIs (81%) than for PEIs (26%) (p<0.001).

Conclusions:

• Implant-based breast reconstruction is a viable option for high-risk women following BRRM.
• Permanent fixed volume implants are recommended over expander implants when feasible (low BMI, small breast volume, no severe ptosis).
• The use of permanent fixed volume implants demonstrates improved reoperation-free survival and is more resource-efficient than expander implants.