LAUSR

Background: Complications including infection and wound dehiscence are major concerns for direct-to-implant breast reconstruction. However, the risk factors associated with severe complications and implant salvage remain unclear. Methods: This was a retrospective study of all patients undergoing unilateral direct-to-implant breast reconstruction from 2014 through 2019. The risk factors associated with complications and prosthesis explantation were identified using multivariate logistic regression modeling and interaction analyses. Results: Among 1027 patients enrolled, 90 experienced severe complications, 41 of whom underwent prosthesis explantation; 49 were successfully salvaged. Multivariate analysis demonstrated that patients with larger implant size (p = 0.003), use of bovine mesh (p < 0.001), adjuvant radiotherapy (p = 0.047), low plasma albumin (p = 0.013), and elevated blood glucose (p = 0.006) were significantly more likely to have complications. Adjuvant radiation therapy (OR, 7.44; 95 percent CI, 1.49 to 37.18; p = 0.014) and obesity (OR, 4.17; 95 percent CI, 1.17 to 14.88; p = 0.028) were associated with significantly lower rates of implant salvage and surgical-site infection and wound dehiscence, whereas mastectomy skin flap necrosis was not associated with device explantation. There were no differences in complication and explantation rates between nipple-sparing and skin-sparing mastectomies. However, the combined impact of surgical-site infection and wound dehiscence added a greater than 14-fold higher risk of prosthesis explantation (95 percent CI, 9.97 to 19.53). Conclusions: Success in direct-to-implant breast reconstruction is multifactorial. Larger implant size, adjuvant radiation therapy, diabetes, and malnutrition demonstrate increased risk of complications in the direct-to-implant approach. Surgical-site infections and wound dehiscence should be treated aggressively, but the combination of both complications portends poor salvage rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.