Experiences of implant loss after immediate implant-based breast reconstruction: qualitative study. Issue 3 (17th March 2020)

• Record Type: Journal Article
• Authors: Mahoney, B; Walklet, E; Bradley, E; Thrush, S; Skillman, J; Whisker, L; Barnes, N; Holcombe, C; Potter, S
• Is Part Of: BJS open. Volume 4:Issue 3(2020)
• Page Start: 380
• Page End: 390
• Publication Date: 2020-03-17
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50275
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Immediate implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK, but almost one in ten women experience implant loss and reconstructive failure after this technique. Little is known about how implant loss impacts on patients' quality of life. The first phase of the Loss of implant Breast Reconstruction (LiBRA) study aimed to use qualitative methods to explore women's experiences of implant loss and develop recommendations to improve care. Methods: Semistructured interviews were conducted with a purposive sample of women who experienced implant loss after immediate IBBR, performed for malignancy or risk reduction across six centres. Interviews explored decision-making regarding IBBR, and experiences of implant loss and support received. Thematic analysis was used to explore the qualitative interview data. Sampling, data collection and analysis were undertaken concurrently and iteratively until data saturation was achieved. Results: Twenty-four women were interviewed; 19 had surgery for malignancy and five for risk reduction. The median time between implant loss and interview was 42 (range 22–74) months. Ten women had undergone secondary reconstruction, two were awaiting surgery, and 12 had declined further reconstruction. Three key themes were identified: the need for accurate information about the risks and benefits of IBBR; the need for more information about 'early-warning' signs of postoperative problems, to empower women to seek help; and better support following implant loss. Conclusion: Implant loss is a devastating event for many women. Better preoperative information and support, along with holistic patient-centred care when complications occur, may significantly improve the experience and outcome of care. Graphical Abstract: Immediate implant-based breast reconstruction is the most commonly performed reconstructive procedure worldwide after mastectomy for breast cancer, but up to one in ten women experience implant loss and reconstructive failure after this technique. This qualitative study explores the experiences of 24 women experiencing implant loss from six centres across the UK. It highlights the need for more balanced presentation of the risks and benefits of different techniques to inform decision-making, the need for better information regarding the early signs of potential problems to empower women to seek help, and more support for patients experiencing this potentially devastating complication. Patients need better support