Immediate breast reconstruction after mastectomy: what are the long-term prospects?

Abstract

Introduction: Immediate breast reconstruction after mastectomy has known psychological and financial advantages but it is difficult to compare the outcome of various methods of reconstruction. Re-operation rates are an objective measure of surgical intervention required to attain and maintain acceptable cosmesis.

Patients and methods: A series of 95 patients (110 immediate reconstructions) was analysed for number of re-operations required within 5 years of initial surgery, magnitude of procedures, 'survival' of the reconstruction and effect of radiotherapy.

Results: Although more intervention was seen in patients with implant-based reconstruction and the time-course over which autologous and implant-based reconstructions fail is different these did not reach statistical significance. Radiotherapy has a significant effect on failure of implant-based reconstruction.

Conclusions: Long-term, large studies of immediate reconstruction are required to assess adequately the impact of type of reconstruction on re-operation rates. The National Mastectomy and Breast Reconstruction Audit is ideally placed to provide answers to remaining questions about longevity of immediate breast reconstruction and the effect that late failure has on patient satisfaction.

Figure 1

Rate of re-operations over time since primary reconstruction. The table reports the number of patients ‘at risk’ for each year of follow-up.

Figure 2

Kaplan-Meier curve of survival of autologous and implant-based breast reconstruction.

Figure 3

Kaplan–Meier graph of survival of implant-based reconstruction according to exposure to radiation. RT, prior radiotherapy or adjuvant irradiation; no RT, no irradiation.