Background: Implant-based reconstruction is the most common method of breast reconstruction in the United States. Despite ongoing advancements, periprosthetic infection is a serious problem that often results in device explantation. The objective of this study was to evaluate the outcomes of third-attempt reconstruction in patients in whom secondary implant-based reconstruction failed owing to infection.
Methods: The authors performed a retrospective review of patients who underwent mastectomy followed by implant-based reconstruction from 2000 to 2019. The outcomes of patients who had failed secondary implant-based reconstruction due to infection and ultimately underwent third-attempt breast reconstruction were analyzed.
Results: Of 6,093 patients who underwent primary implant-based reconstruction, 13 patients had third-attempt breast reconstruction following infection-related explantation (median age, 52 [51-56] years; median body mass index, 23 [22-31] kg/m2; median follow-up of 46 [16-62] months). Nine patients (70%) had implant-based reconstruction, two (15%) had implant-based reconstruction combined with pedicled latissimus dorsi flap, and two (15%) had abdominal-based free tissue transfer. Third-attempt breast reconstruction was immediate in 46% of patients and delayed in 54%. The success rate was 78% in the implant-based reconstruction group, with a 23% complication rate. The success rate for autologous breast reconstruction was 100%, with one patient developing venous congestion necessitating return to the operating room.
Conclusion: Third-attempt breast reconstruction following infection-associated failed secondary implant-based reconstruction is a safe and feasible option. Although the risk of failure is higher than that for primary implant-based reconstruction, a third attempt after secondary IBR infection had a surprisingly high 78% success rate.