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Managing the exposed implant in breast reconstruction
Shoichiro Tanaka, MD, MPH; Douglas Wagner, MD
Summa Health System
2018-02-01
Presenter: Shoichiro A. Tanaka
Affidavit:
This project was designed equally by both Drs. Tanaka and Wagner. Dr. Tanaka was responsible for the acquisition and analysis of the data. Drafting and revision of the abstract was shared by both Drs. Tanaka and Wagner.
Director Name: Douglas Wagner, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: Post-operative implant exposure is a known complication after breast reconstruction, with reported rates of less than 5%. Management of this complication has yet to be standardized with classic teaching suggesting implant removal and staged reconstruction as the primary treatment strategy. While effective, this strategy has not been updated in more than 10 years. We wanted to review the literature to see how implant exposure is being managed and to see if a standard approach could be derived.
Methods: A comprehensive literature review was performed to identify exposure rates among prosthetic-based breast reconstruction between 1990 and 2018. A PubMed search was performed using the keywords "breast reconstruction" matched with "implant," "tissue expander," "exposure," "extrusion," or "salvage." Reconstructive modality, exposure rates, definitions, and treatment algorithms were recorded and reviewed.
Results: An initial search provided 279 articles; 47 articles met inclusion criteria and were reviewed. Thirty-four (72%) articles discussed breast implant exposure and 7 (14.9%) articles provided a treatment algorithm. Management strategies varied among papers, ranging from conservative treatment to operative intervention. Specific indications for each treatment modality varied among authors.
Conclusions: Currently, there is no standard algorithm for treatment of the exposed breast implant. We propose a defined treatment algorithm with specific clinical indicators to guide therapy. A standard treatment algorithm will allow for better patient-centered outcomes.
