Influence of advanced age on postoperative outcomes and total loss following breast reconstruction: a critical assessment of 560 cases

Matsumoto, Walter; Munhoz, Alexandre Mendonça; Okada, Alberto; Montag, Eduardo; Arruda, Eduardo; Fonseca, Alexandre; Ferrari, O; Brasil, José Augusto; Pretti, Lia; Filassi, José Roberto; Gemperli, Rolf

doi:10.1590/0100-6991e-20181616

Cited by 13 publications

(13 citation statements)

References 28 publications

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“…13,40,41 Although a few studies have discussed IBR in young patients, ours is the first to stratify results according to implant placement location. 16,42 Prepectoral reconstruction has the advantage of sparing patients’ muscle-related complications, which can be especially beneficial in this younger higher risk population. 26–29 Although concerns such as rippling and capsular contracture are potential feared complications of prepectoral reconstruction, in recent practice, this has been avoided with the introduction of ADM and fat grafting.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction in Young Women

Manrique

Banuelos

Abu‐Ghname

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Two-staged implant-based reconstruction (IBR) is the most common breast reconstructive modality. Recently, technological and surgical advances have encouraged surgeons to revisit prepectoral IBR. Data comparing prepectoral against subpectoral IBR in women under the age of 40 are lacking. Methods: Retrospective chart review of patients under the age of 40 years old, who underwent immediate 2-staged IBR at our institution, was performed. Patient’s demographics, clinical characteristics, operative details, and early surgical outcomes of prepectoral and subpectoral reconstruction were compared. Data with values of P < 0.05 were considered statistically significant. Results: Between 2012 and 2016, 100 patients (187 breasts) who underwent prepectoral and 69 patients (124 breasts) who underwent subpectoral IBR were included. Median follow-up was 17.9 and 17.5 months in the prepectoral and subpectoral groups, respectively. Total number of complications including both stages of reconstruction was 20 (10.7%) and 19 (15.3%) in the prepectoral and subpectoral groups, respectively ( P = 0.227). Specific complications, including hematoma, seroma, skin flap necrosis, wound dehiscence, and breast infections, were not significantly different among groups. Ten (5.4%) devices, including implants and tissue expander, required explantation in the prepectoral group and 8 (6.5%) in the subpectoral group ( P = 0.683). Explantation was most commonly due to infection (n = 14), and all of them occurred during the first stage ( P < 0.001). Conclusions: Early complications and implant explantation rates are comparable among prepectoral and subpectoral breast reconstruction in women under 40 years old. Based on these results, we believe that prepectoral IBR is a safe, reliable, and promising reconstructive option.

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Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction in Young Women

Manrique

Banuelos

Abu‐Ghname

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…Our study showed that advanced age was not a predictive risk factor for SSC. Conversely, Matsumoto et al 10 in a retrospective study evaluating the effect of advanced age in breast reconstruction, demonstrated that patients older than 60 years had a 1.6 times greater chance of surgical wound complication than the younger patients. There are several limitations to this study similar to retrospective studies using a large database.…”

Section: Discussionmentioning

confidence: 98%

“…However, the rate of surgical site complications in autologous breast reconstruction has been reported in previous studies as high as 49%. 7 - 10…”

Section: Discussionmentioning

confidence: 99%

Frequency and Predictors of 30-Day Surgical Site Complications in Autologous Breast Reconstruction Surgery

Masoomi

Fairchild

Marques

2019

wjps

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BACKGROUND Surgical site complication (SSC) is one of the known complications following autologous breast reconstruction. The aim of this study was to evaluate the frequency and predictors of 30-day surgical site complications in autologous breast reconstruction. METHODS American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database was used to identify patients who underwent autologous breast reconstruction during 2011-2015. Multivariate regression analysis was performed to identify independent perioperative risk factors of SSC. RESULTS Totally, 7,257 patients who underwent autologous breast reconstruction surgery were identified. The majority of the procedures were free flap (60%) versus pedicled flap (40%). The mean age was 51 years and the majority of patients were classified as American Society of Anesthesiologists (ASA)-II (60%) and 15% of patients had BMI>35. The overall 30-day SSC rate was 6.3%. The overall frequency of different types of SSC were superficial incisional infection (3.2%), wound dehiscence (1.8%), deep incisional infection (1.4%) and organ space infection (0.6%). BMI>35 (adjusted odds ratio [AOR]=2.38), smoking (AOR=2.0), diabetes mellitus (AOR=1.67) and hypertension (AOR=1.38) were significant risk factors of SSC. There was no association with age, ASA classification, steroid use, or reconstruction type. CONCLUSION The rate of 30-day SSC in autologous breast reconstruction was noticeable. The strongest independent risk factor for SSC in autologous breast reconstruction was BMI>35. The type of autologous breast reconstruction was not a predictive risk factor for SSC. Plastic surgeons should inform patients about their risk for SSC and optimizing these risk factors to minimize the rate of surgical site complications.

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“…In a study done by Matsumoto et al breasts were divided into three age groups based on the World Health Organization (WHO) classifications [38]. Out of the 153 patients who were in the young group, 63 (41%) had complications [38].…”

Section: Discussionmentioning

confidence: 99%

“…A limited number of studies have assessed the outcomes and complications of IBR in this young group of patients [27,38,39]. Herein, we present our institution’s experience with two-staged, implant-based breast reconstruction, whether immediate or delayed, following either prophylactic or therapeutic mastectomy in patients younger than 40 years of age.…”

Section: Introductionmentioning

confidence: 99%

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

et al. 2019

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Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

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Influence of advanced age on postoperative outcomes and total loss following breast reconstruction: a critical assessment of 560 cases

Abstract: in selected patients, breast reconstruction can be considered safe; most documented complications were limited and could be treated conservatively.

Cited by 13 publications

References 28 publications

Surgical Outcomes of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction in Young Women

Surgical Outcomes of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction in Young Women

Frequency and Predictors of 30-Day Surgical Site Complications in Autologous Breast Reconstruction Surgery

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

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