Significantly reducing implant loss rates in immediate implant-based breast reconstruction: A protocol and completed audit of quality assurance

Summary Introduction Immediate implant-based breast reconstruction (IBR) rates have increased considerably with the advent of acellular dermal matrices. Implant loss is a significant complication and is costly to patients and the NHS. National Mastectomy and Breast Reconstruction Audit and Implant Based Breast Reconstruction Audit data have demonstrated national implant loss rates at 3 months of 9%. National Oncoplastic Guidelines for Best Practice cite a Methods Audit of IBR at a single oncoplastic breast unit was commenced and implant loss at 3 months recorded (May 2012-July 2014). Patients were identified from a prospectively maintained database and case notes examined identifying factors associated with implant loss. A team involving microbiology, theatre staff, infection control and surgeons was established. A novel, evidence-based intervention bundle, including more than 25 protocol changes, was introduced. Prospective re-audit of IBR (April 2015-December 2017) was completed following introduction of the new protocol and implant loss at 3 months recorded. Results The first retrospective audit of 77 reconstructions (54 patients) demonstrated 11 implant losses at 3 months (14%). Re-audit, post intervention, comprised 129 reconstructions (106 patients) with no implant loss at 3 months. Fisher exact analysis revealed statistically significant reduction in implant loss rate (P Conclusions Implant loss rate following IBR can be reduced to an exceptionally low level, well below national targets, by adhering to this evidence-based intervention bundle. Our protocol could improve outcomes nationally 1 .