Analysis of Risk Factors for Complications in Expander/Implant Breast Reconstruction by Stage of Reconstruction

Hirsch, Elliot M.; Seth, Akhil K.; Kim, John Y.S.; Dumanian, Gregory A.; Mustoe, Thomas A.; Galiano, Robert D.; Fine, Neil A.

doi:10.1097/prs.0000000000000607

Cited by 56 publications

(41 citation statements)

References 23 publications

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“…These findings appear to confirm results of previous studies. 23,26,27 In contrast, radiation during or following reconstruction was associated with significantly greater risks for both any and major complications in our analyses. A number of published reports have indicated that radiation following reconstruction is associated with higher complication rates, compared with nonradiated reconstructions.…”

Section: Discussionmentioning

confidence: 59%

Complications in Postmastectomy Breast Reconstruction

et al. 2018

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Objective In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. This study sought to evaluate complications in a large, multicenter patient population. Summary of Background Data Previous studies have reported widely varying complication rates, but have been limited by their single center designs and inadequate controlling for confounders in their analyses. Methods Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction following mastectomy for cancer treatment or prophylaxis. Procedures included expander/implant, latissimus dorsi (LD), pedicle transverse rectus abdominis musculocutaneous (PTRAM), free TRAM (FTRAM), and deep inferior epigastric perforator (DIEP) techniques. Data were gathered pre- and postoperatively from medical records. Separate logistic regressions were conducted for all complications and major complications (those requiring rehospitalization and/or reoperation) within 1 year. Odds ratios (ORs) were calculated for procedure type, controlling for site, demographic, and clinical variables. Results Complication rates for 2234 patients were analyzed. Compared with expander/implant reconstructions, LD (OR) 1.95, P = 0.026), PTRAM (OR 1.89, P = 0.025), FTRAM (OR 1.94, P = 0.011), and DIEP (OR 2.22, P < 0.001) procedures were associated with higher risks of complications. Significantly higher risks were also associated with older age, higher body mass index (BMI), immediate reconstruction, bilateral procedures, and radiation. For major complications, regression showed significantly greater risks for PTRAM (OR 1.86, P = 0.044) and DIEP (OR 1.75, P = 0.004), than expander/implant reconstructions. Failure rates were relatively low, ranging from 0% for PTRAM to 5.9% for expander/implant reconstructions. Conclusion In this multicenter analysis, procedure choice and other patient variables were significant predictors of 1-year complications in breast reconstruction. These findings should be considered in counseling patients on reconstructive options.

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Section: Discussionmentioning

confidence: 59%

Complications in Postmastectomy Breast Reconstruction

et al. 2018

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“…Significant independent risk factors have been previously identified, both in plastic surgery and in other specialities (40,44,45,50,72,(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93). However, the advantage of the present study is the evaluation of four different reconstruction methods with the same criteria for complications.…”

Section: Discussionmentioning

confidence: 86%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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“…For example, in two studies from Fischer and coworkers (24, 25) utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to evaluate complication rates following immediate breast reconstruction, advancing age was not a predictor of post-reconstruction complications. However, in other studies employing similar study designs, older age (variously defined as 45 years or above, over 50 years, or greater than 55 years), conferred an increased risk of complication rates, compared with younger age groups (18, 26, 27). While these studies were adequately powered, they were limited only to complications following immediate reconstruction, and were not designed to specifically evaluate the impact of advancing age on post-reconstruction complication rates.…”

Section: Discussionmentioning

confidence: 94%

“…While other studies have sought to determine the effects of advancing age on breast reconstruction outcomes, they have been largely retrospective in design (14–17) or focused on one type of reconstruction, either implant-based or autologous techniques (15, 18). For our current study, we sought to evaluate the effects of age on postoperative complications and patient-reported outcomes (PROs) in a large multicenter, prospective study of women who underwent breast reconstruction in the United States and Canada.…”

Section: Introductionmentioning

confidence: 99%

Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study

Santosa

Kim

et al. 2016

Journal of the American College of Surgeons

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Background Although over 40% of new breast cancer diagnoses in the U.S. are in older women, few studies have assessed the outcomes of post-mastectomy reconstruction in this population. Our objective was to evaluate age effects on postoperative complications and patient-report outcomes (PROs) in women undergoing breast reconstruction, and to investigate whether age effects differ between reconstructive procedure types. Study Design Eligible patients in the Mastectomy Reconstruction Outcomes Consortium study from 11 institutions (57 providers) in North America were analyzed. Two-year complications and PROs via BREAST-Q domains were compared across younger (<45 years), middle-aged (45–60 years), and older (>60 years) women. Mixed-effects regression models were used, controlling for a range of demographic and clinical covariates. Results A total of 1,531 patients were studied: 494 younger, 803 middle-aged, and 234 older. Age was not a significant predictor of complications. For sexual well-being two years post-reconstruction, older women reported 4.25 (p=0.04) higher mean scores with implant procedures, and 10.39 (p<.01) higher mean scores with autologous procedures compared to younger women. No age effect was seen with implant procedures with regards to physical and psychosocial well-being; however, older women who underwent autologous procedures reported 6.07 (p<.01) higher physical and 8.21 (p<.01) higher psychosocial well-being scores than younger women. Conclusions Age did not significantly affect complication rates. Older women demonstrated higher sexual well-being for both procedures, and better satisfaction, physical and psychosocial well-being than younger women with autologous procedures. Post-mastectomy reconstruction is a viable option for older patients, with risks and benefits comparable to those in younger women.

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Analysis of Risk Factors for Complications in Expander/Implant Breast Reconstruction by Stage of Reconstruction

Cited by 56 publications

References 23 publications

Complications in Postmastectomy Breast Reconstruction

Complications in Postmastectomy Breast Reconstruction

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study

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