Risk Factors For Complications And Implant Loss After Prepectoral Implant-Based Immediate Breast Reconstruction: Medium-Term Outcomes In A Prospective Cohort

Background Prepectoral implant-based breast reconstruction with acellular dermal matrix has become an increasingly popular option for selected patients. There are no randomized data to demonstrate short- or long-term outcomes. Cohort studies to date have demonstrated safety, but risk factors for complications are unknown. Methods This was a prospective cohort study of all patients undergoing prepectoral implant-based breast reconstruction between 2013 and 2019. Clinical factors and those related to reconstruction were analysed in relation to complications and implant loss using univariable and multivariable logistic regression. Results A total of 469 reconstructions were undertaken in 289 women; the majority of reconstructions were performed using a one-stage direct-to-implant technique with acellular dermal matrix. Median follow-up was 21 (range 2-71) months. Minor complications were seen after 11 center dot 2 per cent of reconstructions, major complications after 5 center dot 9 per cent, and the rate of implant loss by 3 months was 3 center dot 1 per cent. In the final multivariable model, sentinel node biopsy (odds ratio (OR) 5 center dot 06, 95 per cent c.i. 2 center dot 00 to 12 center dot 80), axillary clearance (OR 6 center dot 67, 1 center dot 17 to 37 center dot 94) and adjuvant radiotherapy (OR 7 center dot 11, 1 center dot 60 to 31 center dot 61) were independent risk factors for development of a major complication, and sentinel node biopsy (OR 4 center dot 32, 1 center dot 23 to 15 center dot 22) for implant loss. Conclusion Prepectoral implant-based breast reconstruction has acceptable medium-term results but careful patient selection is advised.