Revision Surgery to Improve Cosmesis with Immediate Implant-Based Breast Reconstruction.

BACKGROUND

Following mastectomy for breast cancer, patients may be presented with a range of reconstructive options. The most popular being immediate implant-based reconstruction (IBR).

OBJECTIVE

To determine the rate of revision surgery to improve cosmesis following IBR.

DESIGN

Retrospective cohort study.

SETTING/PATIENTS: All patients who underwent IBR at a single UK-based specialist breast reconstructive centre between June 2012 and June 2013.

MEASUREMENTS

The authors collected data, including demographics, original surgery, revision surgeries and factors likely to influence the cosmetic result.

RESULTS

A total of 88 procedures were included in the study and follow up was performed for a mean duration of 1125 days. In all, 39 breasts required further revision to improve cosmesis to undergo a total of 53 additional procedures. Lipomodelling was the most frequently performed revision (n = 18), whilst implant exchange (n = 16), implant removal (n = 11) and other minor revisions (n = 8) made up the remainder. An early (<3 months) complication, adjuvant radiotherapy and capsular contracture significantly increased the chance of revision surgery (p = 0.018, p = 0.04 and p = 0.009, respectively). Revision surgery added an additional monetary cost of 27.1%-74.1%, which depends on the original procedure performed.

LIMITATIONS

The risk of further revision surgery is likely to be higher in those who are followed up for longer periods.

CONCLUSIONS

Following immediate IBR, revision surgery represents a substantial burden to the patient including healthcare costs.