Smoking and obesity up risk of early implant loss in women who undergo mastectomy and immediate breast reconstruction with implants, according to new research in the December issue of the Journal of the American College of Surgeons.

The findings, which have sired a unique risk-scoring tool, may help surgeons better tailor preoperative risk counseling and improve patient selection.

Researchers led by John P. Fischer, MD, a plastic surgery resident at the Perelman School of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, analyzed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database on 14,585 women between the ages of 40 and 60 who had undergone immediate breast reconstruction.

According to the findings, smoking makes a woman’s risk of early implant loss three times higher, and obesity confers a two to three times greater risk of early implant loss.

The heavier the patient, the greater the risk of early implant loss, the study showed. 

Other factors associated with a greater chance of complications during the early postoperative period included being aged 55 or older and operative risk factors such as bilateral reconstruction and direct-to-implant reconstruction.

New Risk Assessment Tool

The researchers created a simple, usable, clinical risk assessment tool that allows surgeons to predict early implant loss based on these results. This tool enables surgeons to come up with a composite risk score for each patient based upon her individual risk factors. The more risk factors, the greater chance of having a postoperative implant loss within 30 days. For instance, a woman considering bilateral reconstruction who is overweight and a smoker is going to be in a very high-risk group compared with a woman who is a non-smoker, of normal weight, and considering a unilateral implant.

These results may help guide surgical decision-making. “If a patient learns she has a high risk for complications with breast implants, she may choose to have an autologous tissue-based procedure. The risk might not be worth it, or, on the other hand, the patient accepts the risk. Either way, the expectations are better managed and overall satisfaction is likely to be higher,” Fischer said in a news release.