84 Chapter 6 2021 were identified from the DBIR. Patients in whom an autologous adjunctive reconstruction was used and patients with missing data on the variables of the multicenter risk model were excluded. Multicenter risk model Data from the multicenter risk model for implant loss were extracted and used in this study for validation of the results. Details on methods, results and conclusions were published previously.9 In short, 297 breasts in 225 patients were evaluated after implant-based breast reconstruction. The occurrence of implant loss was 11.8%. A risk model was created that identified the following risk factors for implant loss: obesity (defined as body mass index (BMI) >30 kg/m2), active smoking status, nipple sparing procedure and a DTI approach. The corresponding beta regression coefficients and odds ratios were extracted and are depicted in Table 1. The predicted implant loss risk ranged from 3.6% to 78.2% in patients with zero to four risk factors.9 Table 1. Data from multicenter risk model The four risk factors in the multicenter risk model and corresponding beta regression coefficients. Risk factors Beta regression OR P-value Obesity 1.381 1 2.877 (1.299-6.376) 0.009 Active smoking 1.172 13.280 (1.498-7.181) 0.003 Nipple preserving 1.110 13.081 (1.460-6.502) 0.003 Reconstruction type 0.902 13.130 (1.483-6.610) 0.003 Constant -3.286 ORs and P-values are presented. OR indicates odds ratio, significant P-values are noted in italic. Outcome measures and definitions The primary outcome was implant loss due to a wound healing related complication. The following outcomes available in the DBIR were considered as implant loss: (1) explantation of TE or permanent implant because of flap problems, infection, skin necrosis, hematoma, seroma or when no reason was provided; (2) planned replacement of TE with permanent implant combined with flap problems, infection and skin necrosis; (3) unplanned replacement of TE with permanent implant because of flap problems, infection, skin necrosis, hematoma or seroma; (4) replacement of TE or permanent implant with TE because of flap problems, infection, skin necrosis, hematoma, seroma or when no reason was provided; (5) replacement of TE or permanent implant with autologous tissue combined with flap problems, infection or skin necrosis; (6) replacement of permanent implant
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