Experiences of implant loss after immediate implant-based breast reconstruction: A qualitative study

Background: Immediate implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK but almost one-in-ten women will experience implant loss and reconstructive failure following this technique. Little is known about how implant loss impacts on patients’ quality of life. The first phase of the LiBRA study aimed to use qualitative methods to explore women’s experiences of implant loss and develop recommendations to improve care. Methods: Semi-structured interviews were conducted with a purposive sample of women who experienced implant loss following immediate IBBR, performed for malignancy or risk-reduction across six centres. Interviews explored decision-making regarding IBBR and experiences of implant loss and support received. Thematic analysis was used to explore the qualitative interview data. Sampling, data collection and analysis were undertaken concurrently and iteratively until data saturation was achieved. Results: Twenty-four patients were interviewed; 19 had surgery for malignancy and five for risk-reduction. The median time between implant loss and interview was 42 (range 22-52) months. Ten women had undergone secondary reconstruction; two were awaiting surgery and 12 had declined further reconstruction. Three key themes were identified. These were the need for: i) accurate information about the risks and benefits of IBBR, ii) more information about ‘early-warning’ signs of post-operative problems to empower women to seek help, and iii) better support for patients following implant loss. Conclusions: Implant loss is a devastating event for many women. Better preoperative information and support, along with holistic patient-centred care when complications occur, may significantly improve the experience and outcome of care.