A Comparison of Surgical Complications in Patients Undergoing Delayed versus Staged Tissue-Expander and Free-Flap Breast Reconstruction

Shammas, Ronnie L.; Cason, Roger W.; Sergesketter, Amanda R.; Glener, Adam D.; Broadwater, Gloria; Hollins, Andrew; Le, Elliot; Marks, Caitlin; Atia, Andrew; Orr, Jonah; Hollenbeck, Scott T.

doi:10.1097/prs.0000000000008208

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…23 While a complex interaction of factors influences the timing and staging of breast reconstruction, delayed reconstruction is often performed when post-mastectomy radiation therapy (PMRT) is required, which has been shown to confer a greater risk of wound infections. 12,25 However, this was not reflected in our cohort as no difference in surgical site infections was identified.…”

Section: Discussionmentioning

confidence: 85%

“…Similar findings have been reported in the literature. 12 23 24 Though differences in the initial stage of TE placement have been identified in DIBR when compared with DBR, Shammas et al demonstrated no difference in complications in TE exchange to autologous tissue in DIBR compared with the DBR cohort. 3 Additionally, DIBR using autologous tissue has been shown to have comparable outcomes to autologous reconstruction performed after explanation following infection in IBR, suggesting that DIBR may be preferred to IBR in high-risk individuals who may be predisposed to infection.…”

Section: Discussionmentioning

confidence: 99%

“…However, at the time of autologous flap reconstruction, there was no significant difference in complications between the two cohorts. 12 Additionally, Albino et al compared aesthetic outcomes between DIBR and DBR and found that DIBR had a significantly higher overall aesthetic score suggesting that preservation of the native mastectomy skin may allow for improved aesthetic outcomes. 13…”

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confidence: 99%

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A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010–2020 NSQIP Data

Marquez

Sudduth

Kuo

et al. 2023

J Reconstr Microsurg

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Introduction While many factors influence decisions related to the timing between mastectomy and flap-based breast reconstruction, there is limited literature comparing postoperative complications between immediate (IBR), delayed immediate (DIBR), and delayed (DBR) reconstruction modalities. Using the National Surgical Quality Improvement Program (NSQIP), we sought to compare postoperative complication rates of each timing modality. Methods The NSQIP 2010-2020 database was queried for patients who underwent free flap breast reconstruction. Cases were categorized to include mastectomy performed concurrently with a free flap reconstruction, removal of a tissue expander with free flap reconstruction, and free flap reconstruction alone which are defined as IBR, DIBR, and DBR, respectively. The frequency of postoperative outcomes including surgical site infection (SSI), wound dehiscence, intraoperative transfusion, deep venous thrombosis (DVT), and return to operating room (OR) were assessed. Overall complication rates, hospital length of stay (LOS), and operative time were analyzed. Multivariable regression analysis controlling for age, race, BMI, diabetes, hypertension, ASA class, and laterality was performed. Results A total of 7907 cases that underwent IBR, DIBR (n=976), and DBR reconstruction (n=6713) were identified. No statistical difference in occurrence of SSI’s, wound dehiscence, or DVT were identified. DIBR (9%) and DBR (11.9%) were associated with less occurrences of reoperation than IBR (13.2%, p<0.001). Univariate and multivariate regression analysis demonstrated that DIBR and DBR were associated with a lower odds of complications and shorter operation time versus IBR. No statistically significant differences between DIBR and DBR in surgical complications, LOS, and operative time were identified. Conclusion Awareness of overall complication rates associated with each reconstructive timing modality can be used to help guide physicians when discussing reconstructive options. Our data suggests that DIBR and DBR are associated with less overall complications than IBR. Physicians should continue to consider patients’ unique circumstances when deciding upon which timing modality is appropriate.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010–2020 NSQIP Data

Marquez

Sudduth

Kuo

et al. 2023

J Reconstr Microsurg

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“… 10 This increased complication rate was supported in a separate institutional review that described significantly increased rates of surgical complications that predominately occurred after mastectomy in the first reconstructive stage with tissue expander placement. 11 …”

Section: Discussionmentioning

confidence: 99%

Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis

et al. 2022

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Background There is a lack of consensus detailing the optimal approach to free-flap breast reconstruction when considering immediate, delayed, or staged techniques. This study compared costs, complications, and healthcare resource utilization (HCRU) across staged, delayed, and immediate free-flap breast reconstruction. Patients and Methods Retrospective study using MarketScan databases to identify women who underwent mastectomies and free-flap reconstructions between 2014 and 2018. Complications, costs, and HCRU [readmission, reoperation, emergency department (ED) visits] occurring 90 days after mastectomy and 90 days after free flap were compared across immediate, delayed, and staged reconstruction. Results Of 3310 women identified, 69.8% underwent immediate, 11.7% underwent delayed, and 18.5% underwent staged free-flap reconstruction. Staged reconstruction was associated with the highest rate (57.8% staged, 42.3% delayed, 32.0% immediate; p < 0.001) and adjusted relative risk [67% higher than immediate (95% CI: 49–87%; p < 0.001)] of surgical complications. Staged displayed the highest HCRU (staged 47.9%, delayed, 38.4%, immediate 25.2%; p < 0.001), with 16.5%, 30.7%, and 26.5% of staged patients experiencing readmission, reoperation, or ED visit, respectively. The adjusted probability of HCRU was 206% higher (95% CI: 156–266%; p < 0.001) for staged compared with immediate. Staged had the highest mean total cost (staged $106,443, delayed $80,667, immediate $76,756; p < 0.001) with regression demonstrating the adjusted mean cost for staged is 31% higher (95% CI: 23–39%; p < 0.001) when compared with immediate. Conclusions Staged free-flap reconstruction is associated with increased complications, costs, and HCRU, while immediate demonstrated the lowest. The potential esthetic benefits of a staged approach should be balanced with the increased risk for adverse events after surgery. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-12896-0.

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“…The disadvantage of this approach is that by waiting, the patient endures the negative psychologic implications of not having a breast or having a deformed breast until the reconstruction is performed. In addition, with delayed reconstruction there is scarring and fibrosis that forms as part of the healing process that may impact the type of reconstruction that can be performed at a later date [27,28].…”

Section: Delayed Reconstructionmentioning

confidence: 99%

Breast Reconstructive Options

Liliav¹,

Torres-Strauss²

2023

Breast Cancer Updates

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Breast reconstructive options have evolved over the past six decades. Despite advancements in technology, improved therapeutic options, and genetic testing, women are still, unfortunately, faced with a myriad of deformities after treatments for breast cancer. In order to restore an esthetically pleasing breast mound, a careful evaluation of the patient must be taken into account. There are, generally, three components or factors that need to be considered while devising an excellent reconstructive option for a particular patient. These are: patient factors, surgeons’ factors, and oncologic factors. It is only with a detailed understanding of each one of these factors that a sound solution is arrived at. In this chapter, we will explore the various modalities of breast reconstruction available to patients. We will also demonstrate specific considerations in order to optimize an excellent outcome for our breast cancer patients.

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A Comparison of Surgical Complications in Patients Undergoing Delayed versus Staged Tissue-Expander and Free-Flap Breast Reconstruction

Cited by 10 publications

References 25 publications

A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010–2020 NSQIP Data

A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010–2020 NSQIP Data

Complications, Costs, and Healthcare Resource Utilization After Staged, Delayed, and Immediate Free-Flap Breast Reconstruction: A Longitudinal, Claims-Based Analysis

Breast Reconstructive Options

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