title: Long-term outcomes of failed prosthetic breast reconstruction.
abstract: BACKGROUND
  For patients undergoing prosthetic breast reconstruction whose device was removed because of infection or exposure, there is no published information examining long-term outcomes. Despite initial failure, many patients want to pursue breast reconstruction.
  
  
  METHODS
  A retrospective review was performed of immediate prosthetic breast reconstruction failures during a 5-year period.
  
  
  RESULTS
  A total of 26 patients (29 breasts) were identified who failed primary prosthetic 2-stage reconstruction. On average, the device was removed 262 days from the initial expander placement. Of these breasts, 19 were removed for infection, 7 for exposure, and 3 for a combination of both. Of these 29 failures, secondary reconstruction was attempted in 20 (69%). Among secondary reconstructions, 13 were with a device and 7 with autologous tissue. Of the 13 (92.3%) secondary device reconstructions, 12 were successful.Those in whom secondary reconstruction was attempted were younger at initial reconstruction (48 vs 57 years; P = 0.038), had lower body mass indexes (BMIs) (26.0 vs 29.4; P = 0.27), and smaller breasts (650 vs 979 g; P = 0.23) than those who did not attempt secondary reconstruction.Of the nipple-sparing mastectomy patients, 100% underwent secondary reconstruction, whereas only 61% of skin-sparing mastectomy patients underwent secondary reconstruction (P = 0.14).For patients undergoing secondary reconstruction, those receiving a second device reconstruction had lower BMIs (24.7 vs 28.5; P = 0.18) and smaller breasts (489 vs 946 g; P = 0.08) than those with autologous reconstructions; 15% of secondary implant reconstructions underwent irradiation versus 43% of the secondary autologous reconstructions (P = 0.29).
  
  
  CONCLUSIONS
  After failed prosthetic breast reconstruction, a second attempt with an implant in properly selected patients has a high success rate (92.3%).
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. spears@gunet.georgetown.edu
authors.forename: Scott L
authors.initials: SL
authors.lastname: Spear
authors.forename: Derek
authors.initials: D
authors.lastname: Masden
authors.forename: Samir S
authors.initials: SS
authors.lastname: Rao
authors.forename: Maurice Y
authors.initials: MY
authors.lastname: Nahabedian
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000295:instrumentation; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery*; D015625:Tissue Expansion Devices; D017211:Treatment Failure