Reconstructing Failure: Assessing Surgical and Patient-Reported Outcomes after Loss of Initial Breast Reconstruction.

Area of Science:

• Plastic Surgery
• Oncology
• Patient-Reported Outcomes

Background:

• Breast reconstruction failure, involving prosthetic device or flap removal without replacement, is a significant patient concern.
• Understanding the trajectory of tissue expander (TE), implant, or autologous breast reconstruction failure is crucial for patient management.
• Assessing patient-reported outcomes (PROs) after reconstructive failure is essential for evaluating treatment effectiveness.

Purpose of the Study:

• To describe the progression of breast reconstructive failures using tissue expanders, implants, or autologous methods.
• To evaluate patient-reported outcomes (PROs) in patients undergoing additional breast reconstruction after failure.
• To compare outcomes of secondary reconstruction with uncomplicated initial reconstructions.

Main Methods:

• A retrospective review of patients undergoing breast reconstruction (TE, implant, autologous) between 2017-2022.
• Identification of patients experiencing reconstructive failures and subsequent secondary reconstruction.
• Analysis of BREAST-Q scores and propensity-matched comparison between secondary and uncomplicated reconstructions.

Main Results:

• High rates of secondary reconstruction were observed following TE (49.5%) and autologous (53.8%) failures, contrasting with implant failures (4.8%).
• Factors like age, psychiatric diagnosis, chemotherapy, radiation, and mastectomy type influenced the likelihood of pursuing secondary reconstruction.
• Patients undergoing secondary reconstruction showed a trend towards higher Psychosocial Well-being scores, with comparable PROs to those with uncomplicated initial reconstructions at one year.

Conclusions:

• Less than half of patients with breast reconstruction failure opt for additional reconstruction.
• Secondary reconstruction may lead to improved Psychosocial Well-being and comparable long-term outcomes.
• Surgeons should discuss the potential benefits of secondary reconstruction with patients experiencing reconstructive failure.