Impact of procedure type on revisional surgery and secondary reconstruction after immediate breast reconstruction in a population-based cohort

Johnson, Leigh; White, Paul; Holcombe, Chris; O’Donoghue, Joe; Jeevan, Ranjeet; Browne, John; Fairbrother, Patricia; Mackenzie, Mairead; Gulliver-Clarke, Carmel; Mohiuddin, Syed; Hollingworth, Will; Potter, Shelley; O'Donoghue, Joe

Abstract

Background: Women considering immediate breast reconstruction require high-quality information about the likely need for secondary reconstruction and the long-term risk of revisional surgery to make fully informed decisions about different reconstructive options. Such data are currently lacking. This study aimed to explore the impact of reconstruction type on the number of revisions and secondary reconstructions performed 3, 5, and 8 years after immediate breast reconstruction in a large population-based cohort. Methods: Women undergoing unilateral mastectomy and immediate breast reconstruction for breast cancer or ductal carcinoma in situ in England between 1 April 2009 and 31 March 2015 were identified from National Health Service Hospital Episode Statistics. Numbers of revisions and secondary reconstructions in women undergoing primary definitive immediate breast reconstruction were compared by procedure type at 3, 5, and 8 years after index surgery. Results: Some 16 897 women underwent immediate breast reconstruction with at least 3 years' follow-up. Of these, 14 069 had a definitive reconstruction with an implant only (5193), latissimus dorsi flap with (3110) or without (2373) an implant, or abdominal free flap (3393). Women undergoing implant-only reconstruction were more likely to require revision, with 69.5 per cent (747 of 1075) undergoing at least one revision by 8 years compared with 49.3 per cent (1568 of 3180) in other reconstruction groups. They were also more likely to undergo secondary reconstruction, with the proportion of women having further reconstructive procedures increasing over time: 12.8 per cent (663 of 5193) at 3 years, 14.3 per cent (535 of 3752) at 5 years, and 17.6 per cent (189 of 1075) at 8 years. Conclusion: Long-term rates of revisions and secondary reconstructions were considerably higher after primary implant-based reconstruction than autologous procedures. These results should be shared with patients to support informed decision-making.

• Journal Article Type: Article
• Acceptance Date: Feb 5, 2023
• Online Publication Date: Mar 31, 2023
• Publication Date: Jun 30, 2023
• Deposit Date: Apr 18, 2023
• Publicly Available Date: Apr 18, 2023
• Journal: British Journal of Surgery
• Print ISSN: 0007-1323
• Electronic ISSN: 1365-2168
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 110
• Issue: 6
• Pages: 666-675
• DOI: https://doi.org/10.1093/bjs/znad050
• Keywords: Revisional surgery; secondary reconstruction; breast reconstruction; breast surgery
• Public URL: https://uwe-repository.worktribe.com/output/10625724
• Publisher URL: https://academic.oup.com/bjs/advance-article/doi/10.1093/bjs/znad050/7096779
• Additional Information: Presented to the Association of Breast Surgery Conference, May 2022, and a meeting of British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), Nottingham, UK, November 2022; published in abstract form as EJSO 2022;48:e191–e192