Chia Chun Lee(李嘉駿)

  • Complications and Patient-Reported Outcomes after Implant-based Breast Reconstruction: A 10-year Experience at Taipei Veterans General Hospital

    Background:
    Implant-based, or alloplastic, breast reconstruction is a well-established method to restore body image and alleviate distress associated with mastectomy. Substantial literature has described complications and patient-reported outcomes following such operative method. We sought to evaluate clinical outcomes and risk factors for complications. Furthermore, we present patient’s satisfaction and quality of life(QoL) after implant-based breast reconstruction from a single institution’s experience.

    Materials and Methods:
    A retrospective chart review was conducted for all patients who received primary implant-based breast reconstruction after mastectomy from 2009 to 2018 at Taipei Veterans General Hospital. Patients were inquired with BREAST-Q, a condition-specific patient-reported outcome (PRO) measure after surgery.

    Results:
    A total of 164 patients with 170 breasts were identified. Among which, 144 (85%) were two-stage tissue expander-based and 26 (15%) were single-stage direct-to-implant reconstruction. 130 (76%) received non-nipple sparing mastectomy compared to 40 (24%) who received nipple sparing mastectomy. Mean follow up was 85.1 months. Overall Complication rate was 37%, with infection as most common in 17 patients (10%). In an adjusted regression model, smoking (p=0.037), nipple sparing mastectomy (p=0.007) and Mentor brand implants (p=0.014) were significant risk factors for overall complications. BMI (p=0.017), DM (p=0.004), direct-to-implant (p=0.049) and seroma (p=0.034) were significant risk factors for individual complications. Questionnaire response rate was 42.7%(70/164) at least 6 months post treatment. After analysis was controlled for baseline values, patients who underwent single-stage direct-to-implant had greater satisfaction with implants than those who underwent tissue expander-based reconstruction (mean difference, -1.91; p=0.02).

    Conclusion:
    Complications following implant-based breast reconstruction attribute to both patient-related and operative-related factors, which had interactions between each other. Despite these obstacles, precise patient selection may be key to achieving successful outcomes with good aesthetic results. This finding may provide information for surgeons and women when making breast reconstruction decisions.

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