Abstract P2-13-10: Expanding the scope of implant based reconstruction; Good results can be achieved in challenging and high-risk patients
Authors: Rowland MP , Kandola S , Teasdale RL , Kirwan CC , Harvey JR , Henderson JR , Riding DM 
Published: May 2016

Aims: Implant based reconstruction can be challenging, especially in higher risk patients, resulting in implant loss, poor cosmesis and delayed wound healing. We assessed outcomes of higher risk patients with a multi-centre study, including 5 hospitals in the North West of England. Our trainee-led, regional data collection removes any single surgeon or institution bias.

Methods: A multi-centre, retrospective review of implant-based reconstructions between 01/01/12 & 31/12/12 was performed. Rates of implant loss from complications, unplanned explantation for cosmesis and delayed wound healing were assessed for those deemed at high risk (obese BMI&gt;30, Smokers, previous chest wall radiotherapy (RT), elderly &gt;65years, underweight BMI&lt;20 & neo-adjuvant chemotherapy(NAC)).

Results:216 reconstructions were assessed, with follow-up for minimum of 24 months. 117/216 patients had at least one of the high-risk features of which; 59 were obese, 50 smokers, 28 previous RT, 18 elderly, 10 underweight & 7 had NAC. Reconstructive strategy in the High Risk group was implant/expander only 42 (36%), implant & flap 35(30%), implant- ADM 27(23%), implant & dermal-Sling 11(9%),& other 2(2%), vs. the Low Risk group (n=99); implant/expander only 29(29%), implant & flap 22(22%), implant-ADM 35(35%), implant & dermal-sling 9(9%), & other 4(4%).

Of the 59 obese patients 10(17%) implants were explanted (6 for complications and 4 for unplanned cosmetic revision) and 14(24%) had delayed wound healing, compared to 18(11%) explant and 22(14%) delayed wound healing in non-obese; suggesting obesity increases risk in implant reconstruction (p0.36 & p0.1 respectively).

Smoking is associated with increased risk, with 13(26%) implants lost (9 from infection & 4 for unplanned cosmetic revision) compared to 15(9%) in non-smokers (p&lt;0.01) and 12(24%) having delayed wound healing compared to 24(14%) (p=0.1).

Of the 28 patients who had previous RT the predominant reconstructive strategy was implant with LD-flap (17/28, 61%). Of all RT patients, 5(18%) implants were lost (3 for complications, 2 unplanned revision) compared to 12% in non-RT patients. Delayed wound healing was common; 10(36%) compared to 26(13%) (p0.01).

Implant based reconstruction in the elderly, underweight and NAC groups have similar implant loss and delayed wound heal rates as the non-RF comparison groups, see table 1.

Table 1Risk Factor [RF] (n)Implant loss in patients with RF(%)Implant loss in patients without RFpDelayed wound healing in patients with RF(%)Delayed wound healing in patients without RF(%)pObese (59)17110.3624140.10Smoking (50)269&lt;0.0124140.10Previous RT (36)18120.373613&lt;0.01Older age (18)0140.4810181.00Low BMI (10)6140.376170.30NAC (7)14131.0014171.00

Only 6/216(3%) patients were diabetic, suggesting surgeons may negatively select this patient group for implant reconstruction.

Conclusions; Implant based reconstruction is feasible in many of the higher risk, challenging patients that are encountered in a UK NHS practice. However even with the limited numbers of high-risk patients in this study smoking and RT, are associated with increased risk.

Citation Format: Rowland MP, Kandola S, Teasdale RL, Kirwan CC, Harvey JR, Henderson JR, Riding DM. Expanding the scope of implant based reconstruction; Good results can be achieved in challenging and high-risk patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-13-10.