A Brand-New Drainage Fluid Predictor, ICAM-1 for Implant Loss After the Immediate Reconstruction of Breast.

Abstract

<h4>Background</h4>Nearly 40% of breast cancer patients are ineligible for breast-conserving surgery. Immediate implant-based breast reconstruction is a preferred option for these patients. The most severe complication of this procedure is implant loss. Currently, there are no cytokines available to predict implant failure. To identify a drainage biomarker predicting implant loss and evaluate whether dexamethasone irrigation in high-risk cases is associated with reduced implant failure, we designed this study.<h4>Methods</h4>A retrospective cohort study was conducted between December 2022 and March 2024, patients undergoing mastectomy with immediate implant-based reconstruction were recruited. We applied protein microarray to analyze cytokines in the drainage fluid from the implant pocket to identify cytokines associated with implant failure.<h4>Results</h4>We initially selected 3 patients with implant failure and 3 with successful implant outcomes as the cohort for protein microarray analysis. Drainage fluid samples were collected and analyzed at 3 time points: 24 hours postoperatively, at drainage removal and at the onset of implant failure. This analysis identified intercellular adhesion molecule-1 (ICAM-1) as a candidate marker that meets the criteria for predicting implant failure. Subsequently, we validated ICAM-1's predictive potential in a separate cohort of breast cancer patients who underwent immediate implant-based breast reconstruction between December 2022 and March 2024. Our results demonstrated that ICAM-1 levels in drainage fluid at the time of drainage removal effectively predicted implant failure following immediate breast reconstruction for breast cancer. Additionally, a retrospective analysis revealed that intracavitary irrigation with dexamethasone significantly reduced ICAM-1 level in the drainage fluid and reversed impending implant failure.<h4>Conclusion</h4>The data confirmed the potential of ICAM-1 as a predictive factor for breast implant failure. Intracavitary irrigation with dexamethasone was effective to prevent implant loss.