Predictive risk factors of complications in different breast reconstruction methods

Abstract

Purpose Women with different BMI, age and comorbidities seek for breast reconstruction. It is critical to understand the risk associated with each technique to ensure the most appropriate method and timing is used. Outcome after reconstructions have been studied, but consensus is lacking regarding predictive risk factors of complications. The authors present their experience of different autologous and alloplastic reconstructions with an emphasis on predictors of complications. Methods Prospectively maintained reconstruction database from 2008 to 2019 was reviewed. Factors associated with complications were identified using logistic regression, multinomial logistic regression and risk factor score to determine predictors of complications. Results A total of 850 breast reconstructions were performed in 793 women, including 447 DIEP, 283 LD, 12 TMG and 51 implant reconstructions. Complications included minor (n = 231, 29%), re-surgery requiring (n = 142, 18%) and medical complications (n = 7, 1%). Multivariable analysis showed that complications were associated independently with BMI > 30 (OR 1.59; 95% CI 1.05-2.39, p = 0.027), LD technique (OR 4.05; 95% CI 2.10-7.81, p < 0.001), asthma or chronic obstructive pulmonary disease (OR 2.77; 95% CI 1.50-5.12, p = 0.001) and immediate operation (OR 0.69; 95% CI 0.44-1.07, p = 0.099). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the risk score increased (35%, 61%, 76% and 100% for 1, 2, 3 and 4 risk scores, respectively, p < 0.001). Conclusions The rate of complication can be predicted by a risk-scoring system. In increasing trend of patients with medical problems undergoing breast reconstruction, tailoring of preventive measures to patients' risk factors and careful consideration of the best timing of reconstruction is mandatory to prevent complications and costs.

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

“…First, Chang et al observed significantly higher rates of complications in overweight and obese patients having a breast reconstruction with free TRAM flaps [ 1 ]. Besides higher frequencies of lower abdominal bulging and herniation due to increased intraabdominal pressure in overweight patients [ 17 , 18 ], several studies confirmed a significantly higher overall risk for complications after reconstructions with abdominal based free flaps [ 3 , 4 , 19 , 20 , 21 , 22 , 23 ]. As an example, Boczar et al [ 4 ] observed a reoperation rate of about 40% in obese patients and severe wound complications.…”

Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis

“…Six NRCSs reported risks of overall (or "any") complications. Seven of these NRCSs (Chetta 2017, Kouwenberg 2020, Kulkarni 2017, Mak 2020, Palve 2020, Qin 2018, and Simon 2020), reported that, between 1 month and 3.7 years of followup, risks were higher among patients who underwent AR than those who underwent IBR (adjORs ranged from 1.36 to 8.28). Kulkarni 2017 reported separate comparisons between various AR flap types and IBR; risks of overall complications were higher for each flap group (DIEP, free TRAM, pedicled TRAM, LD, and SIEA) than the IBR group at both 1 and 2 years.…”

Breast Reconstruction: Necessity for Further Standardization of the Current Surgical Techniques Attempting to Facilitate Scientific Evaluation and Select Tailored Individualized Procedures Optimizing Patient Satisfaction

“…More specifically, while prepectoral implant placement is a promising technique, appropriate patient selection is crucial. Evolution in NSM techniques, emphasis on intraoperative skin flap assessment, assessment of patients’ skin flap thickness and vascularity, have led to improved skin flap viability, which has reintroduced the prepectoral prosthetic breast reconstruction approach [33-36].…”