Factors That Influence the Completion of Breast Reconstruction

Abstract

Post mastectomy breast reconstruction continues to evolve in both timing and technique; however, multiple surgical procedures are usually required. The purpose of this report was to determine the number of secondary procedures required to complete the breast reconstruction and factors that influence this process. All patients who underwent breast reconstruction at Emory University Hospital between 1975 and 2000 were reviewed. The end point and inclusion criterion was completion to nipple reconstruction. Secondary procedures were determined per patient for either unilateral or bilateral reconstructions, and defined as any surgical manipulation of the reconstructed breast, contralateral breast, or donor site. The cohort was stratified by timing and method of reconstruction. Additional variables included risk factors, radiation therapy, and complications. A total of 888 patients completed the reconstructive process (738 unilateral and 150 bilateral). The average number of secondary procedures was 3.99 for unilateral, and 5.54 for bilateral. Delayed reconstructions had a higher number of secondary procedures in both groups. Transverse rectus abdominus musculocutaneous flap reconstruction tended to have more secondary procedures than implant or latissimus dorsi with or without implant reconstructions. Radiation therapy increased the number of secondary procedures in unilateral (3.9 versus 4.6, P < 0.001) and in bilateral reconstructions (5.7 versus 6.4, P = 0.032). The number of secondary procedures also increased exponentially with the number of risk factors (0-4), and patients with any complication had a higher number of secondary procedures for unilateral (4.5 versus 3.6, P < 0.001) and bilateral reconstructions (6.4 versus 4.5, P < 0.001). Secondary breast and donor site procedures were used as an outcome measure to formulate comparisons. Autologous tissue reconstruction required more secondary procedures, likely in part to donor site revisions. Delayed reconstruction, the need for radiation therapy, any complication, and more risk factors significantly increased the number of secondary procedures required to complete the reconstructive process.

Immediate postmastectomy reconstruction is associated with improved breast cancer‐specific survival

“…Although a staged approach is often required, many secondary procedures can be performed under local anesthesia and are of minimal risk. 19,20 If a patient is eligible to undergo mastectomy, there is little to preclude her medically from being offered implant reconstruction. Tellingly, the estimated apparent survival advantage of reconstruction was particularly strong within this subgroup (HR ¼ 0.47; 95% CI, 0.28 to 0.80).…”

Do Variations in Provider Discussions Explain Socioeconomic Disparities in Postmastectomy Breast Reconstruction?

“…For particular individuals, concerns about cost, prolonged time off from work and the potential need for secondary procedures can also weigh into the decision. 16 However, regardless of what factors are salient, patients cannot meaningfully participate in the decision-making process without an informative discussion of reconstruction that enables them to understand and weigh the risks and benefits.…”

Factores relacionados con la cirugía secundaria en la reconstrucción mamaria autóloga con tejido libre abdominal

“…Losken y Damen señalan una mayor necesidad de cirugías secundarias en reconstrucciones unilaterales, y en reconstrucción autóloga frente a reconstrucción con protésis (8,10). A pesar de que estos resultados deben ser tomados con cautela debido al pequeño tamaño de la muestra de estudio, parece plausible que en las reconstrucciones bilaterales el tratar simultáneamente ambas mamas con la misma técnica pueda disminuir la necesidad de procedimientos de simetrización posteriores.…”

“…Está documentado el aumento en la tasa de complicaciones asociadas a la radioterapia adyuvante en pacientes reconstruidas con colgajos libres (13), pero su influencia sobre la necesidad de cirugías secundarias cuenta con pocos estudios concluyentes (10). En nuestra experiencia, la ausencia de diferencia entre pacientes que han recibido o no radioterapia no es atribuible a falta de potencia del test, puesto que la mediana de ambos grupos, en cuanto al número de procedimientos y cirugías secundarias, es superponible.…”