Risk Factors and Incidence of Reoperation in Direct-to-Implant Breast Reconstruction Surgery Among Patients with Breast Cancer

Abstract

Background. The increasing incidence of breast cancer leads to the increasing number of mastectomies and frequency of immediate breast reconstruction, particularly using direct-to-implant (DTI) methods. Capsular contracture remains a significant complication in DTI reconstruction, accounting for 10-20% of patients. This study aimed to investigate the incidence and risk factors for capsular contracture in patients with breast cancer undergoing DTI reconstruction using a nationwide cohort in Korea. Patients and Methods. This retrospective cohort study used data from the Korean Health Insurance Review and Assessment Service. Patients with ductal carcinoma in situ or invasive breast cancer who underwent mastectomy and immediate DTI reconstruction from January 2015 to December 2018 were included. Risk factors were analyzed using Cox proportional hazard models. Results. Among 124,237 patients with breast cancer, 4054 underwent immediate DTI reconstruction, with 552 (13.6%) developing capsular contractures requiring surgery. Among the affected patients, 335, 124, and 93 underwent capsulectomy only, both capsulectomy and implant change, and implant change only, respectively. In multivariable Cox analysis, older age (per 10 years: HR 1.25, 95% CI 1.10-1.41, p < 0.001), radiotherapy (HR 1.44, 95% CI 1.11-1.87, p = 0.006), and lymphedema (HR 2.23, 95% CI 1.60-3.09, p < 0.001) were significantly associated with contracture risk. Conclusions. In patients with breast cancer undergoing DTI reconstruction, age, radiotherapy, and lymphedema were significant risk factors for capsular contracture. These findings highlight the importance of individualized preoperative planning and counseling to reduce the risk and improve outcomes. Further research should focus on developing strategies to manage these identified risk factors and prevent capsular contracture.