Significantly reducing implant loss rates in immediate implant-based breast reconstruction: A protocol and completed audit of quality assurance

Knight, H. J., Musgrove, J. J., Youssef, M. M. G. ORCID:, Ferguson, D. J., Olsen, S. B. and Tillett, R. L. (2020) Significantly reducing implant loss rates in immediate implant-based breast reconstruction: A protocol and completed audit of quality assurance. Journal of Plastic, Reconstructive & Aesthetic Surgery, 73 (6). pp. 1043-1049. ISSN 1748-6815

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Introduction: Immediate implant-based breast reconstruction (IBR) rates have increased considerably with the advent of acellular dermal matrices. Implant loss is a significant complication and is costly to patients and the NHS. National Mastectomy and Breast Reconstruction Audit and Implant-Based Breast Reconstruction Audit data have demonstrated national implant loss rate of 9% at 3 months. National Oncoplastic Guidelines for Best Practice cite a < 5% target. We aimed to reduce implant loss by introducing a protocol with pre-, intra- and post-operative interventions. Methods: Audit of IBR at a single oncoplastic breast unit was commenced and implant loss at 3 months was recorded (May 2012-July 2014). Patients were identified from a prospectively maintained database, and case notes were examined by identifying factors associated with implant loss. A team involving microbiology, theatre staff, infection control and surgeons was established. A novel, evidence-based intervention bundle, including more than 25 protocol changes, was introduced. Prospective re-audit of IBR (April 2015–December 2017) was completed following introduction of the new protocol and implant loss was recorded at 3 months. Results: The first retrospective audit of 77 reconstructions (54 patients) demonstrated 11 implant losses at 3 months (14%). Re-audit, post-intervention, comprised 129 reconstructions (106 patients) with no implant loss at 3 months. Fisher's exact analysis revealed statistically significant reduction in implant loss rate (P < 0.00001) following protocol introduction. Conclusions: Implant loss rate following IBR can be reduced to an exceptionally low level, well below national targets, by adhering to this evidence-based intervention bundle. Our protocol could improve outcomes nationally.

Item Type: Article
Uncontrolled Keywords: adm (acellular dermal matrix),biological mesh,implant-based breast reconstruction,oncoplastic,surgery ,/dk/atira/pure/subjectarea/asjc/2700/2746
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 14 Sep 2020 23:51
Last Modified: 22 Oct 2022 06:48
DOI: 10.1016/j.bjps.2019.12.005

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