Implant Loss and Associated Risk Factors following Implant-based Breast Reconstructions

Yara L. Blok*, Evelien van Lierop, Victor D. Plat, Leonard U. M. Corion, Pieter S. Verduijn, Nicole M. A. Krekel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Implant loss is the most severe complication of implant-based breast reconstructions. This study aimed to evaluate the incidence of implant loss and other complications, identify associated risk factors, and create a risk model for implant loss. Methods: This was a retrospective cohort study of all patients who underwent a mastectomy, followed by either a two-stage or a direct-to-implant breast reconstruction. Patient variables, operative characteristics, and postoperative complications were obtained from the patient records. A multivariate mixed-effects logistic regression model was used to create a risk model for implant loss. Results: A total of 297 implant-based breast reconstructions were evaluated. Overall, the incidence of implant loss was 11.8%. Six risk factors were significantly associated with implant loss: obesity, a bra cup size larger than C, active smoking status, a nipple-preserving procedure, a direct-to-implant reconstruction, and a lower surgeon's volume. A risk model for implant loss was created, showing a predicted risk of 8.4%-13% in the presence of one risk factor, 21.9%-32.5% in the presence of two, 47.5%-59.3% in the presence of three, and over 78.2% in the presence of four risk factors. Conclusions: The incidence of implant loss in this study was 11.8%. Six associated significant risk factors were identified. Our risk model for implant loss revealed that the predicted risk increased over 78.2% when four risk factors were present. This risk model can be used to better inform patients and decrease the risk of implant loss by optimizing surgery using personalized therapy.
Original languageEnglish
Article numbere3708
JournalPlastic and Reconstructive Surgery - Global Open
Issue number7
Early online date2021
Publication statusPublished - 2021

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