A nomogram to predict failure rate in immediate implant-based breast reconstruction

Controversies on risk factors affecting immediate implant-based breast reconstruction (IBBR) still exist. We aimed to evaluate risk factors of reconstruction failure (RF) in immediate IBBR. We retrospectively reviewed 239 patients (241 breasts) who underwent immediate IBBR from 2011 to 2019. A nomogram was established to predict RF rate in stage I operation and logistic regression model was created for stage II operation. 14 (5.81%) and 7 (5.51%) reconstructive breasts experienced RF in stage I and II operation, respectively. Body mass index (BMI) [odds ratio (OR)=1.569, 95% confidence interval (CI): 1.087-2.263, p=0.016], implant/tissue expander (TE) volume>86.30% (OR=5.711, 95% CI: 1.067-30.583, p=0.042), adjuvant chemotherapy (ACT) (OR=30.094, 95% CI: 2.030-446.084, p=0.013) were independent risk factors for RF in stage I operation. The nomogram to predict RF rate in stage I operation revealed area under the curve (AUC) was 0.920 (95% CI: 0.844-0.995). Logistic regression demonstrated that mesh use was the independent predictor of RF in stage II operation (OR=47.326, 95% CI: 3.11-720.081, p=0.005). The nomogram exhibited satisfied predictive ability. Present findings enhanced our understanding of the risk factors contributing to RF and might lead us clinical decision to improve the outcome of immediate IBBR.