Reconstructing Failure: Assessing Surgical and Patient-Reported Outcomes after Loss of Initial Breast Reconstruction.

Abstract

Background: Breast reconstruction failure, defined as the removal of a prosthetic device or flap without immediate replacement, can be traumatic. The authors describe the progression of tissue expander (TE), implant, or autologous breast reconstructive failure, and assess the patient-reported outcomes (PROs) among patients who undergo additional reconstruction.

Method: Patients undergoing TE, implant, or autologous breast reconstruction between 2017 and 2022 were included, and patients with reconstructive failures were identified. Outcomes of interests included receipt of additional reconstruction and BREAST-Q scores 1 year after reconstructive failure. The authors also performed a propensity-matched analysis between patients who underwent secondary reconstruction and patients who had an uncomplicated reconstruction.

Results: A total of 4258 patients receiving TEs, 4420 patients receiving implants, and 1545 patients receiving autologous breast reconstruction were included. Of patients who experienced reconstructive failures, 49.5% of patients with TEs, 4.8% of patients with implants, and 53.8% of patients with autologous reconstruction underwent secondary reconstruction. Age, psychiatric diagnosis, chemotherapy, radiation, and mastectomy type were associated with increased likelihood of secondary reconstruction. Between patients with and without additional reconstruction, higher Psychosocial Well-being trended toward the former cohort (61 [interquartile range, 56, 80] versus 50 [46, 65]; P = 0.085). Propensity-matched analysis demonstrated comparable PROs at 1 year after definite reconstruction.

Conclusions: Fewer than half of patients with reconstructive failure undergo an additional reconstruction. Patients who receive secondary reconstruction may have greater Psychosocial Well-being scores than those who do not and comparable PROs to those who had uncomplicated initial reconstruction. Surgeons should counsel patients with reconstructive failures that secondary reconstruction, although traumatizing, may be beneficial.

Clinical question/level of evidence: Risk, III.