96 Chapter 7 ABSTRACT Introduction: Implant loss following implant-based breast reconstruction (IBBR) is a serious complication, resulting in re-operations, patient suffering, and a significant decrease in quality of life. This study aimed to create a validated risk prediction model for implant loss after IBBR using perioperative risk factors. Methods: Patients who had undergone either a two-stage or a direct-to-implant postmastectomy IBBR were identified from the Dutch Breast Implant Registry. The cohort was divided in a training cohort (80%) and a validation cohort (20%). A multivariate logistic regression model was used to create a risk prediction model for implant loss in the training cohort, which was subsequently internally validated in the validation cohort. Implant loss was defined as explantation or replacement of the implant due to postoperative wound healing-related complications within 6 months after placement. Results: A total of 5260 IBBRs were divided into a training cohort and validation cohort. Significant risk factors included in the risk prediction model were: BMI, active smoking status, previous radiotherapy and prepectoral placement. The model was able to predict an increasing probability of implant loss from 4.5% without any risk factors to 38.0% if four risk factors were present. Furthermore, the calibration plot showed good agreement. Conclusion: Nationwide population-based data were extracted from the Dutch Breast Implant Registry and used to create a risk assessment model for implant loss after implant-based breast reconstruction. The model was accurately internally validated, making it applicable to general practice and a valuable aid in preoperative counseling of women who consider implant-based breast reconstruction.
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