A study found that 44% of women with locally advanced breast cancer underwent unplanned implant removal after mastectomy, reconstruction, and postmastectomy radiation (PMRT), as reported in The Breast Journal.
“A better understanding of the true risk of unplanned implant removal will help women make more informed decisions and have more realistic expectations of the risks of implant-based breast reconstruction after treatment for locally advanced breast cancer,” the researchers concluded.
The study evaluated 52 patients who underwent mastectomy, reconstruction, and PMRT from 2010 to 2017. Most patients had stage III disease (44.2%) and were estrogen receptor positive (76.9%) and human epidermal growth factor receptor 2 (HER2) positive (75.0%).
With a median follow-up of 3.1 years, 44% of patients experienced an unplanned implant removal. The median time to implant removal was 5.4 months.
Removal occurred in 17% of patients before starting PMRT and in 27% of patients after starting PMRT. Rates of removal were the same for hypofractionated PMRT as for standard fractionation and similar for proton compared with photon PMRT.
Among the reasons provided for implant removal before PMRT were infection (44%), wound breakdown (33%), hematoma (11%), and concern about impending radiation (11%). After PMRT, reasons given for implant removal were breast asymmetry (57%), infection (21%), deflated expander (14%), and seroma (7%).
Specific evaluation of the 34 patients with bilateral reconstruction showed that implant removal was more common due to a complication in the breast with cancer (11/34; 33%) compared with the contralateral breast (15%; P = .04).
“Despite the relatively high rate of implant removal reported in this study, salvage reconstruction is feasible,” the researchers noted. “Of the 23 patients who experienced unplanned implant removal, 78% were able to undergo salvage reconstruction with only 5 patients pursuing no further reconstruction at the time of last follow-up.”
Anderson JD, Hammond JB, Kosiorek HE, et al. Unplanned implant removal in locally advanced breast cancer. Breast J. Published online March 14, 2021. doi:10.1111/tbj.14224