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., 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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Abstract

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: 14 Sep 2020 23:51
URI: https://ueaeprints.uea.ac.uk/id/eprint/76858
DOI: 10.1016/j.bjps.2019.12.005

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