Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer

Abstract

Objective To evaluate complications after post-mastectomy breast reconstruction, particularly in the setting of adjuvant radiotherapy. Summary-Background Data Most studies of complications after breast reconstruction have been conducted at centers of excellence; relatively little is known about complication rates in radiated patients treated in the broader community. This information is relevant for breast cancer patients' decision-making. Methods Using the claims-based MarketScan database, we described complications in 14,894 women undergoing mastectomy for breast cancer from 1998-2007 who received immediate autologous reconstruction (n=2637), immediate implant-based reconstruction (n=3007), or no reconstruction within the first two postoperative years (n=9250). We used a generalized estimating equation to evaluate associations between complications and radiotherapy over time. Results Wound complications were diagnosed within the first two postoperative years in 2.3% of patients without reconstruction, 4.4% with implants, and 9.5% with autologous reconstruction (p<0.001). Infection was diagnosed within the first two postoperative years in 12.7% of patients without reconstruction, 20.5% with implants, and 20.7% with autologous reconstruction (p<0.001). 5219 (35%) women received radiation. Radiation was not associated with infection in any surgical group within the first six months but was associated with an increased risk of infection in months 7-24 in all three groups (each p<0.001). In months 7-24, radiation was associated with higher odds of implant removal in patients with implant reconstruction (OR 1.48, p<0.001) and fat necrosis in those with autologous reconstruction (OR=1.55; P=0.01). Conclusions Complication risks after immediate breast reconstruction differ by approach. Radiation therapy appears to modestly increase certain risks, including infection and implant removal.

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

“…However, almost 30% of these patients eventually did not receive radiation therapy after mastectomy. Multiple studies and reviews showed that post-mastectomy radiation therapy is associated with a higher incidence of complications and implant loss (18)(19)(20)(21)(22). Furthermore, literature states that radiation therapy has a negative impact on cosmetic outcome, due to often severe Gland Surg 2017;6(1):43-48 gs.amegroups.com capsular contracture after implant-based reconstruction (21)(22)(23)(24)(25).…”

Reoperation Costs in Attempted Breast-Conserving Surgery: A Decision Analysis

“…Based on our decision analysis, if the current reoperation rate in Canada were to be lowered to 10% from 23%, the average savings per patient in the population undergoing initial attempted bcs would be $1,055. That amount is likely an underestimate because it does not take into account the costs associated with any complications that might occur out of hospital 26,27 or any secondary procedures for complications, which are more likely in patients who choose mastectomy and reconstruction 48 . The economic implications are significant, especially in a publicly funded universal health care system, given that the potential savings are at least $1.9 million annually in the province of British Columbia alone.…”

“…It might also delay the initiation of adjuvant chemotherapy. As an alternative, many patients elect to undergo mastectomy with or without reconstruction, which is a vastly different clinical course, associated with higher complications 26,27 . Moreover, the need for secondary procedures has a significant economic cost, which is of particular concern in a publicly funded health care system.…”

Falls-risk in senior women after radical treatment of breast cancer

“…Many authors highlight that the treatment of breast cancer causes many side effects, which may hamper overall coordination of the systems involved in physical activity, thus significantly reducing individual ability to perform physical actions. The reasons for reduced physical performance include pain, swelling of the lymphs, decreased mobility, and decreased muscle strength leading to a reduction in physical activity and an energy-limiting lifestyle [6][7][8][9][10][11][12].…”