Does Immediate Tissue Expander Placement Increase Immediate Postoperative Complications in Patients with Breast Cancer?

Abstract

The objectives of this study were to evaluate 1) the rate of immediate breast reconstruction; 2) the frequency of immediate tissue expander placement; and 3) to compare perioperative outcomes in patients who underwent breast reconstruction after mastectomy for breast cancer with immediate tissue expander placement (TE) with those with no reconstruction (NR). Using the Nationwide Inpatient Sample database, we examined the clinical data of patients with breast cancer who underwent mastectomy with or without immediate TE from 2006 to 2010 in the United States. A total of 344,253 patients with breast cancer underwent mastectomy in this period in the United States. Of these patients, 31 per cent had immediate breast reconstruction. We only included patients with mastectomy and no reconstruction (NR: 237,825 patients) and patients who underwent only TE placement with no other reconstruction combination (TE: 61,178 patients) to this study. Patients in the TE group had a lower overall postoperative complication rate (2.6 vs 5.5%; P < 0.01) and lower in-hospital mortality rate (0.01 vs 0.09%; P < 0.01) compared with the NR group. Fifty-three per cent of patients in the NR group were discharged the day of surgery compared with 36 per cent of patients in the TE group. Using multivariate regression analyses and adjusting patient characteristics and comorbidities, patients in the TE group had a significantly lower overall complication rate (adjusted odds ratio [AOR], 0.6) and lower in-hospital mortality (AOR, 0.2) compared with the NR group. The rate of immediate reconstruction is 31 per cent. TE alone is the most common type of immediate reconstruction (57%). There is a lower complication rate for the patients who underwent immediate TE versus the no-reconstruction cohort.

Influence of Triple-Negative versus Luminal A Breast Cancer Subtype on Choice of Autologous versus Implant-Based Delayed-Immediate Breast Reconstruction

“…16 With respect to reconstructive timing, immediate TE placement is not shown to increase postoperative complications compared with no reconstruction. 17 In a large review of nipple-sparing mastectomy patients, immediate TE placement is shown to have less mastectomy flap complications compared with immediate implant or autologous-based reconstruction. 18 In our practice, many patients are offered delayed-immediate reconstruction, with rare conversion to delayed reconstruction based on the intraoperative examination of the mastectomy flaps.…”

Breast Reconstruction Use and Impact on Surgical and Oncologic Outcomes Amongst Inflammatory Breast Cancer Patients—A Systematic Review

“…Complication rates following immediate breast reconstruction in IBC patients appear comparable with those in non-IBC patients [39][40][41]. Notably, Hoffman et al found no difference in 30-and 90-day mortality and 30-day readmission rates between immediate reconstruction and no reconstruction [19], suggesting that for select patients, mastectomy with immediate reconstruction is a feasible procedure with minimal impact on short-term surgical morbidity and mortality [42,43]. There was no clinically significant difference in time to post-mastectomy radiotherapy (PMRT) between the breast reconstruction and no-reconstruction groups, although the data is limited.…”

Exposed Implant after Immediate Breast Reconstruction – Presentation and Analysis of a Clinical Management Protocol

“… 7 8 9 10 Among the different types of breast reconstruction, implant-based surgery is the most common option. 1 2 11 Several studies 12 13 14 15 have already demonstrated that this type of reconstruction is not associated with a negative impact on the oncologic results of breast cancer treatment, or with an increased risk of developing postoperative complications when compared with mastectomy alone.…”