Long-term outcomes of breast reconstruction and the need for revision surgery

Ben Finlay; Victoria Kollias; Kelly A Hall; Zackariah Clement; Janne Bingham; Robert Whitfield; James Kollias; Melissa Bochner

doi:10.1111/ans.17118

Long-term outcomes of breast reconstruction and the need for revision surgery

ANZ J Surg. 2021 Sep;91(9):1751-1758. doi: 10.1111/ans.17118. Epub 2021 Aug 10.

Authors

Ben Finlay¹, Victoria Kollias¹, Kelly A Hall², Zackariah Clement¹, Janne Bingham^{1

3}, Robert Whitfield¹, James Kollias^{1

3}, Melissa Bochner^{1

3}

Affiliations

¹ Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
² Adelaide Health Technology Assessment, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
³ Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.

PMID: 34375030
DOI: 10.1111/ans.17118

Abstract

Background: Breast reconstruction (BR) often forms part of a patient's breast cancer journey. Revision surgery may be required to maintain the integrity of a BR, although this is not commonly reported in the literature. Different reconstructive methods may have differing requirements for revision. It is important for patients and surgeons to understand the factors leading to the need for revision surgery.

Methods: This retrospective cohort study analyses BRs performed by oncoplastic breast surgeons in public and private settings between 2005 and 2014, with follow-up until December 2018. Surgical and patient factors were examined, including types of BR, complications and reasons for revision surgery.

Results: A total of 390 women with 540 reconstructions were included, with a median follow-up of 61 months. Twenty-eight percent (151/540) of reconstructions required at least one revision operation. Overall, implant-based reconstructions (direct-to-implant [DTI] and two-stage expander-implant) had a higher revision rate compared to pedicled flap reconstructions (odds ratio 1.91, 95% confidence interval 1.08, 3.38). DTI reconstructions had the highest odds, and pedicled flap without implants the lowest odds of requiring revision. Post-reconstruction radiotherapy increased the chance of revision surgery, while pre-reconstruction radiotherapy did not. Odds of revision were higher in implant-based reconstructions compared to pedicled flap reconstructions that had radiotherapy. Other factors increasing the rates of revision surgery were being a current smoker and post-operative infection.

Conclusion: Almost one-third of reconstructive patients require revision surgery. Autologous pedicled flap reconstructions have lower rates of revision compared to implant-based reconstructions. Radiotherapy increases the need for revision surgery, particularly in implant-based reconstructions.

Keywords: breast; breast neoplasms; breast reconstruction; breast surgery; general surgery; oncoplastic surgery; plastic and reconstructive surgery.

MeSH terms

Breast Implants*
Breast Neoplasms* / surgery
Female
Humans
Mammaplasty*
Mastectomy
Postoperative Complications / epidemiology
Reoperation
Retrospective Studies
Tissue Expansion Devices