73 Implant loss and associated risk factors following implant-based breast reconstruction Table 3. Postoperative outcomes of implant-based breast reconstructions with and without implant loss Data are n (%) or median (range). Significant p-values are denoted in italics. SSI indicates surgical site infection. Postoperative outcomes No implant loss (n = 262) Implant loss (n = 35) p-value* Seroma 46 (17.6) 4 (11.4) 0.363 SSI 34 (13.0) 19 (54.3) < 0.001 Dehiscence 7 (2.7) 8 (22.9) < 0.001 Necrosis (general) 10 (3.8) 22 (62.9) < 0.001 Nipple necrosis 7 (2.7) 14 (40) < 0.001 Hematoma 32 (12.2) 4 (11.4) 1.000 Drainage days 3 (0–16) 3 (0–8) 0.891 Individual risk factors After adjusting for confounders, six factors were significantly associated with implant loss. These risk factors included obesity (defined as BMI > 30) (adjusted OR: 3.226, p = 0.020), a bra cup size larger than C (adjusted OR: 3.132, p = 0.015), active smoking status (adjusted OR: 3.935, p = 0.009), a nipple-preserving procedure (adjusted OR: 4.182, p = 0.004), DTI reconstruction (adjusted OR: 2.609, p = 0.032), and a lower surgeon’s volume (adjusted OR: 3.070, p = 0.019 and adjusted OR: 4.086, p = 0.010 between a volume of > 50 and 25–50 or < 25, respectively). Subgroup analysis stratified for TE or DTI did not result in significant risk factors after adjusting for confounders. All factors and their correlation with implant loss before and after adjusting for confounders are summarized in Table 4. Risk model After multivariate stepwise backward regression analysis, the following risk factors remained significant and were included in the risk model: obesity, nipple-sparing procedure, active smoking status, and a DTI approach. The risk of implant loss was predicted by the number of risk factors present and is depicted in Table 5. 5
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