Mahoney B, Walklet E, Bradley E, Thrush S, Skillman J, Whisker L, Barnes N, Holcombe C, Potter S
School of Psychology, College of Business, Psychology and Sport, University of Worcester, Worcester, UK.
College of Health, Life and Environmental Sciences, University of Worcester, Worcester, UK.
BJS Open. 2020 Jun;4(3):380-390. doi: 10.1002/bjs5.50275. Epub 2020 Mar 17.
Immediate implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK, but almost one in ten women experience implant loss and reconstructive failure after this technique. Little is known about how implant loss impacts on patients' quality of life. The first phase of the Loss of implant Breast Reconstruction (LiBRA) study aimed to use qualitative methods to explore women's experiences of implant loss and develop recommendations to improve care.
Semistructured interviews were conducted with a purposive sample of women who experienced implant loss after immediate IBBR, performed for malignancy or risk reduction across six centres. Interviews explored decision-making regarding IBBR, and experiences of implant loss and support received. Thematic analysis was used to explore the qualitative interview data. Sampling, data collection and analysis were undertaken concurrently and iteratively until data saturation was achieved.
Twenty-four women were interviewed; 19 had surgery for malignancy and five for risk reduction. The median time between implant loss and interview was 42 (range 22-74) months. Ten women had undergone secondary reconstruction, two were awaiting surgery, and 12 had declined further reconstruction. Three key themes were identified: the need for accurate information about the risks and benefits of IBBR; the need for more information about 'early-warning' signs of postoperative problems, to empower women to seek help; and better support following implant loss.
Implant loss is a devastating event for many women. Better preoperative information and support, along with holistic patient-centred care when complications occur, may significantly improve the experience and outcome of care.
即刻乳房植入重建术（IBBR）是英国最常用的重建手术，但近十分之一的女性在接受该技术后会出现植入物丢失和重建失败的情况。对于植入物丢失如何影响患者的生活质量，人们知之甚少。乳房重建植入物丢失（LiBRA）研究的第一阶段旨在运用定性方法，探究女性植入物丢失的经历，并提出改善护理的建议。
对在六个中心因恶性肿瘤或降低风险而接受即刻IBBR术后出现植入物丢失的女性进行了有目的抽样的半结构化访谈。访谈探讨了关于IBBR的决策、植入物丢失的经历以及获得的支持。采用主题分析法对定性访谈数据进行探究。抽样、数据收集和分析同时且反复进行，直至达到数据饱和。
共访谈了24名女性；其中19名因恶性肿瘤接受手术，5名因降低风险接受手术。植入物丢失至访谈的中位时间为42（范围22 - 74）个月。10名女性接受了二次重建，2名等待手术，12名拒绝进一步重建。确定了三个关键主题：需要获得关于IBBR风险和益处的准确信息；需要更多关于术后问题“预警”迹象的信息，以使女性有能力寻求帮助；以及在植入物丢失后获得更好的支持。
植入物丢失对许多女性来说是一个毁灭性事件。更好的术前信息和支持，以及并发症发生时以患者为中心的整体护理，可能会显著改善护理体验和结果。
