70 Chapter 5 Postoperative outcomes The most frequently reported complication was SSI, which occurred in 53 (17.7%) implant-based breast reconstructions, with 16 (5.4%) requiring surgical intervention (CD ≥ 3). SSI was reported at median postoperative day 18. Seroma was reported in 50 (16.8%) implant-based breast reconstructions and was reported in the electronic patient files at median postoperative day 13. One case of seroma (0.3%) resulted in a CD score of ≥ 3. Skin or nipple necrosis was described in 32 (10.8%) implant-based breast reconstructions, which appeared on median postoperative day 11 and led to a CD score of ≥ 3 in 21 cases (7.1%). Implant loss occurred after 35 (11.8%) implantbased breast reconstructions, with a yearly variation in incidence of 5.5%–18.3%. The implant was surgically removed on median postoperative day 36. In 10 of the 35 breasts (28.6%), the extruded implant was replaced within the same surgical procedure. The underlying complications in these 10 breasts were SSI, necrosis, or wound dehiscence. Additional postoperative data are summarized in Table 1. Table 1. Summary of clinical course The data are numbers and percentages of total breast reconstructions (n = 297); postoperative day is presented as median and range. CD: Clavien-Dindo; SSI: surgical site infection Postoperative outcomes Number Postoperative day CD ≥ 3 Seroma 50 (16.8) 13 (7–33) 1 (0.3) SSI 53 (17.7) 18 (3–220) 16 (5.4) Dehiscence 15 (5.1) 29 (8–137) 7 (2.4) Necrosis 32 (10.8) 11 (0–29) 21 (7.1) Implant leakage 7 (2.4) 192 (54–474) 7 (2.4) Hematoma 36 (12.1) 11 (0–61) 5 (1.6) Implant loss 35 (11.8) 36 (9–362) 35 (11.8) Drainage days 3 (0–16) Baseline characteristics were compared between all implant-based breast reconstructions with and without implant loss (35 vs 262 breasts, respectively). A significantly higher BMI was reported in implant-based breast reconstructions with implant loss compared with those without implant loss (median 27.3 vs 24.1, p = 0.007). Furthermore, a bra cup size larger than C (48.6% vs 27.1%, p = 0.012) and active smoking (34.3% vs 13.4%, p = 0.002) were more frequently reported in the group with implant loss. Operative time was prolonged (median 170 vs 135 minutes, p < 0.001), mastectomy specimen weights were higher (median 571 vs 385 grams, p = 0.003), the nipple was more frequently preserved (62.8% vs 37.0%, p = 0.002), the TE size was larger (median 500 vs 400, p = 0.005), and a higher perioperative TE filling was applied (median 200 vs 150, p = 0.008) in the implant loss group compared with the group without implant loss. All preoperative and
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