C. Slovacek1, M. Asaad2, D. Mitchell1, J. Selber2, A. Mericli2, M. Clemens2, C. Butler2 1Mcgovern Medical School,Houston, TEXAS, USA 2MD Anderson Cancer Center, Houston, TX,Department Of Plastic Surgery,Houston, TEXAS, USA
Introduction: Infection is the most common reason for device explantation in implant-based breast reconstruction (IBR). Although it is reasonable to offer secondary IBR following first device removal, these patients are still at risk for subsequent infections which can lead to a repeat explantation. Whether further attempts of IBR should be pursued following two failed IBR is unknown. The goal of this study is to evaluate the outcomes of the third IBR following two failed attempts of IBR due to infection.
Methods: We conducted a retrospective review of all patients who underwent a third IBR attempt following two sequential infected IBR explantation between 2008 and 2019. Our primary outcome measure was reconstructive failure. Secondary outcome measures included overall complications and infection.
Results: A total of 6093 IBR were performed between 2008 and 2019, out of whom 298 (5%) underwent first IBR removal due to infection and 116 underwent secondary IBR (24 of whom with LD). Out of 16 patients who had two failed IBRs due to infection, we identified 13 patients who attempted a third reconstruction while 3 patients did not pursue reconstruction. The mean age of the third reconstruction group was 53±6 years and mean BMI was 29±8 kg/m2. Six patients (46%) received previous radiotherapy. In total, 7 patients (54%) underwent reconstruction with a permanent implant, 2 (15%) received a tissue expander (TE), 2 (15%) received TE followed by an implant, and 2 (15%) had a free flap. The mean follow-up was 43 ± 29 months.
Overall complication rate was 31% (n=4). Infection developed in 3 IBR patients (23%), 2 of whom ultimately had their device removed. One patient with a free flap developed flap venous thrombosis which was salvaged during an operative take-back. Overall, 11 (85%) had successful tertiary reconstruction.
Conclusion: In patients who had failed secondary IBR due to infection, a third breast reconstruction should be considered. However, this is associated with high infection and failure rates. This information would help in patients’ counseling and decision making.