title: Delayed breast implant reconstruction: a 10-year prospective study.
abstract: Studies of complications following reconstructive surgery with implants among women with breast cancer are needed. As the, to our knowledge, first prospective long-term study we evaluated the occurrence of complications following delayed breast reconstruction separately for one- and two-stage procedures. From the Danish Registry for Plastic Surgery of the Breast, which has prospectively registered data for women undergoing breast implantations since 1999, we identified 559 women without a history of radiation therapy undergoing 592 delayed breast reconstructions following breast cancer during the period 1999 to 2006; 239 one-stage procedures and 353 two-stage procedures. The postoperative course through November 2009 was evaluated by cumulative incidence adjusting for competing risks for the selected outcomes; hematoma, infection, seroma, implant rupture, severe capsular contracture (modified Baker III and IV), extrusion of the implant, asymmetry/displacement of the implant, any complication, and reoperation. These analyses were performed both overall and separately according to type of procedure (one- or two-stage). The overall 10-year risk estimates were 68.1% for any complication, 7.7% for severe capsular contracture, 32.3% for displacement/asymmetry of the implant and 38.6% for reoperation. When comparing one- and two-stage procedures, we observed significantly higher risk estimates for infection, seroma and extrusion of the implant following two-stage procedures, whereas the risk of reoperation was significantly higher following the one-stage procedure. For both procedures, the majority of reoperations were due to asymmetry or displacement of the implant. In conclusion, non-radiated one- and two-stage delayed breast implant reconstructions are associated with substantial risks of complications and reoperation which should be taken into consideration in the planning of breast reconstruction.
authors.affiliation: Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. hvilsom@cancer.dk
authors.forename: Gitte B
authors.initials: GB
authors.lastname: Hvilsom
authors.forename: Lisbet R
authors.initials: LR
authors.lastname: Hölmich
authors.forename: Marianne
authors.initials: M
authors.lastname: Steding-Jessen
authors.forename: Kirsten
authors.initials: K
authors.lastname: Frederiksen
authors.forename: Trine F
authors.initials: TF
authors.lastname: Henriksen
authors.forename: Loren
authors.initials: L
authors.lastname: Lipworth
authors.forename: Joseph K
authors.initials: JK
authors.lastname: McLaughlin
authors.forename: Jens Jørgen
authors.initials: JJ
authors.lastname: Elberg
authors.forename: Tine E
authors.initials: TE
authors.lastname: Damsgaard
authors.forename: Søren
authors.initials: S
authors.lastname: Friis
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome