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

H. J. Knight, J. J. Musgrove, M. M. G. Youssef, D. J. Ferguson, S. B. Olsen, R. L. Tillett

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20 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1043-1049
Number of pages7
JournalJournal of Plastic, Reconstructive & Aesthetic Surgery
Issue number6
Early online date27 Dec 2019
Publication statusPublished - 1 Jun 2020


  • ADM (acellular dermal matrix)
  • Biological mesh
  • Implant-based breast reconstruction
  • Oncoplastic

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