• Jana de Boniface, Hannah Coudé Adam, Axel Frisell, Ira Oikonomou, Dhirar Ansarei, Anna Ljung Konstantinidou, Yihang Liu, Basel Abo Alniaj, Paula Wallmon, Martin Halle, JohanssonAnna L VALVDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.Cancer Registry of Norway, Oslo, Norway., and Helena Sackey.
• Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
• Br J Surg. 2022 Oct 14; 109 (11): 110711151107-1115.

BackgroundRadiotherapy (RT) is a risk factor for impaired outcomes after implant-based immediate breast reconstruction (IBR). Large studies including long-term follow-up are relatively scarce. The purpose of this analysis was to assess long-term effects of RT in implant-based IBR, distinguishing between implant removal because of postoperative complications versus patient preference.MethodsThis population-based cohort study included all patients with breast cancer who underwent implant-based IBR in Stockholm between 2005 and 2015. Data were collected through national registers and medical charts. The main endpoint was implant removal owing to postoperative complications (wound breakdown, infection, bleeding) or patient preference (dissatisfaction, pain, capsular contracture), with or without conversion to autologous reconstruction.ResultsSome 1749 implant-based IBRs in 1687 women were included. Median follow-up was 72 (range 1-198) months. Reconstructions were divided according to receipt of RT: No RT (n = 856, 48.9 per cent), adjuvant RT (n = 749, 42.8 per cent), and previous RT (n = 144, 8.2 per cent). Implant removal occurred after 266 reconstructions (15.2 per cent); 68 (7.9 per cent) in the no RT, 158 (21.1 per cent) in the adjuvant RT, and 40 (27.8 per cent) in the previous RT group. Implant removal was because of postoperative complications in 152 instances (57.1 per cent) and was most common in the first 3 years. This was especially observed in the previous RT group, where 15 of 23 implant removals occurred during the first 6 months. Implant removal owing to patient preference (114 of 266, 42.9 per cent) became more common with increasing follow-up.ConclusionImplant removal after implant-based IBR is significantly associated with RT. The reason for implant removal shifts over time from postoperative complications to patient preference.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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