Long-term implant survival in delayed breast reconstruction

The primary aim of this study was to establish the incidence of implant-related operations and revisions after delayed implant-based breast reconstruction over a 20-year period.

This study is an ancillary study to the Gothenburg Breast Reconstruction Study (GoBreast; NCT03963427). The first included patient was operated on in 2003, and the last was operated on in 2011. All breast reconstructions were delayed procedures. The Kaplan-Meier method was used to estimate the time until implant loss. Log-rank tests (Mantel-Haenszel) were used for comparisons. A Cox proportional hazards model was used for multivariable analysis, and hazard ratios were estimated.

The study included 881 implants and 603 patients. The mean follow-up for the implants was 8.2 years. With regard to first implants, 17% had at least one unplanned procedure with implant failure. If all implants are pooled together, the 20-year implant survival rate is 57% (95% confidence interval 54 to 61%). Most implants were lost during the first 2 years, but the cumulative risk of implant loss increased steadily with time. When different surgical methods were compared, implant survival was statistically lower for direct-to-implant than for the other techniques (P < 0.001).

About half of the implants in delayed breast reconstructions in this study survived for up to two decades without any additional surgery. Serial implant revisions seem more common than single implant revisions; if the first implant needed revision, there was a tendency for the second implant to also require revision.