Risk Factors for Complications in Expander-Based Breast Reconstruction: Multivariate Analysis in Asian Patients

Suga, Hirotaka; Shiraishi, Tomohiro; Tsuji, Naoko; Takushima, Akihiko

doi:10.1097/gox.0000000000001563

Cited by 8 publications

(5 citation statements)

References 21 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Yalanis et al reported their results on 253 breast reconstructions, in which mastectomy weights of greater than 500 g were associated with a 10 times higher rate of skin necrosis and 18 times higher when the mass of resected tissue was greater than 1000 g. 10 A second study showed that mastectomy specimens greater than 500 gm are significantly associated with all categories of complications, including seroma formation and skin necrosis. 11,12 Consistent with this finding, the affected patient had very high fluid accumulation volumes (Fig. 1).…”

Section: Discussionsupporting

confidence: 80%

Toward Drainless Breast Reconstruction: A Pilot Study

Patel

Kulber

Ray

2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Implant-based breast reconstruction with immediate tissue expander placement is the predominant form of breast reconstruction in the United States. Closed-suction drains are frequently employed to minimize seroma accumulation, although they carry the risk of serving as a port of entry for bacteria, posing a concern in the presence of implanted materials such as breast implants or acellular dermal matrix. Introduction of a dual-port tissue expander designed to facilitate the collection and removal of seroma fluid provides a new way of performing breast reconstruction without external drains. Methods: We conducted a pilot study using the AlloX2 dual-port expander on five consecutive patients to demonstrate feasibility of this approach at Cedars-Sinai Medical Center by the two senior authors (E.R. and D.K.). Results: Patients averaged seven clinic visits before they were ready for expander exchange, totaling a mean of 137.5 days. Patients averaged 1.9 clinic visits before output was less than 40cm 3 (1.6 for right breasts and 2.2 for left breasts), with two of the patients never reaching that output. There was one complication; a single patient had unilateral flap necrosis and implant exposure due to excessively large breasts and thin skin flaps, necessitating expander removal and latissimus flap reconstruction. The other four patients underwent successful implant reconstruction. Conclusions: This pilot study demonstrates the feasibility of breast reconstruction without external drains using a dual-port expander with built-in seroma reservoir. From these results, it is apparent that dual-port tissue expanders with built-in seroma reservoir offer a safe and effective way to perform breast reconstruction without drains in appropriately selected patients. A larger prospective cohort will be needed to definitively demonstrate lower infection and reconstructive failure rates.

show abstract

Section: Discussionsupporting

confidence: 80%

Toward Drainless Breast Reconstruction: A Pilot Study

Patel

Kulber

Ray

2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…Smoking was found to increase the risk of developing postoperative complications after reconstruction with autologous flaps (11)(12)(13)(14) and following alloplastic BR (15)(16)(17). However, not all research is equivocal on this aspect (18)(19)(20). For example, a study on tissue expansion did not find smoking to be a risk factor for developing complications, possibly due to low smoking incidence in that study population (8%) (21).…”

Section: Introductionmentioning

confidence: 99%

“…Because of the disparity in results published on smoking and BMI in relation to complications after alloplastic BR (18)(19)(20)(21)26), we set out to evaluate the effect of smoking, BMI ⩾ 25, and other possible risk factors on the occurrence of complications after alloplastic BR at our study centers. The outcome of this study may help improve individual counseling for women who contemplate to undergo BR with implants or tissue expanders (TEs) after prophylactic mastectomy or breast cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Smoking and Body Mass Index on The Complication Rate of Alloplastic Breast Reconstruction

et al. 2019

View full text Add to dashboard Cite

Background and Aims: The aim of this study was to evaluate the effect of smoking and body mass index on the occurrence of complications after alloplastic breast reconstruction. Materials and Methods: A consecutive series of 56 patients treated with immediate or delayed alloplastic breast reconstruction, including six cases combined with latissimus dorsi flap, at three hospitals between 2012 and 2018 were included. Complications were scored and defined according to Clavien–Dindo. To evaluate the impact of smoking, body mass index, and other potential risk factors on the occurrence of any and severe complications, univariate and multivariate logistic regression analyses were applied to estimate odds ratios and 95% confidence intervals. Results: In 56 patients, 22 patients had a complication. As much as 46% of smokers had severe complications compared to 18% of non-smokers. Of patients with body mass index ⩾ 25, 40% had severe complications compared to 10% with body mass index < 25. Smokers had eight times more chance of developing severe complications than non-smokers (ORadjusted = 8.0, p = 0.02). Patients with body mass index ⩾ 25 had almost 10 times more severe complications compared to patients with body mass index ⩽ 25 (ORadjusted = 9.9, p = 0.009). No other risk factors were significant. Conclusion: Smoking and body mass index ⩾ 25 both increased the complication rate to such an extent that patients should be informed about their increased risk for complications following alloplastic breast reconstruction and on these grounds surgeons may delay alloplastic breast reconstruction. It is an ethical dilemma whether one should deny overweight and obese patients and those who smoke an immediate alloplastic breast reconstruction. For both life style interventions, adequate guidance should be made available.

show abstract

“…(470.17 ± 243.15 versus 319 ± 173.8, respectively), meaning larger skin flap surface area, which can cause less blood flow to the distal skin edges [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Is Using Closed Incision Negative Pressure Therapy in Reconstructive and Oncoplastic Breast Surgery Helpful in Reducing Skin Necrosis?

Al-Ishaq¹,

Rahman²,

Salem³

et al. 2023

Cureus

View full text Add to dashboard Cite

IntroductionSkin necrosis is a major concern of morbidity in patients undergoing reconstructive and oncoplastic breast surgery (ROBS) as it may lead to a poor aesthetic outcome, necessitate further surgery, and delay adjuvant chemotherapy and radiotherapy if required postoperatively. Some studies have reported that closed incision negative pressure therapy (ciNPT) immediately after surgery can reduce the incidence of wound complications. Our study aimed to investigate the effect of ciNPT on skin necrosis rate after ROBS. MethodsOur study included 82 patients in a single center who underwent 121 ROBS procedures. We used conventional dressing in 42 patients (62 procedures, group A), while we used ciNPT in 40 patients (59 procedures, group B). When ciNPT dressing was introduced in our breast unit, 40 patients with 59 ROBS procedures who had ciNPT dressing were studied prospectively. The risk factors recorded were age, body mass index (BMI), history of previous radiotherapy, history of smoking, type of incision, type of operation, breast tissue specimen weight, use of neoadjuvant chemotherapy, and implant size. Skin necrosis was classified as "minor" if it was managed conservatively with regular dressings and "major" if surgical debridement in theater and/or exchange or implant removal was necessary. ResultsThe incidence of overall skin necrosis in the conventional dressing group was 17.7% (11/62), while in the ciNPT group, it was higher at 25.4% (15/59), although this was not statistically significant (p = 0.51). ciNPT also did not show a statistically significant difference from the conventional dressing in the rate of minor necrosis (18.6% versus 11.2%, respectively; p = 0.44) and major necrosis (6.7% versus 6.4%, respectively; p = 1.00) ConclusionOur data has shown no superiority of ciNPT in reducing skin necrosis rate in a patient undergoing reconstructive and oncoplastic breast surgery, contrary to many other published reports. However, it may have reduced rates of other wound complications such as wound dehiscence, wound infection, and hypertrophic scar formation, which were not studied in our cohort. Further studies are needed to confirm its benefits, especially in high-risk patients.

show abstract

Risk Factors for Complications in Expander-Based Breast Reconstruction: Multivariate Analysis in Asian Patients

Cited by 8 publications

References 21 publications

Toward Drainless Breast Reconstruction: A Pilot Study

Toward Drainless Breast Reconstruction: A Pilot Study

The Effect of Smoking and Body Mass Index on The Complication Rate of Alloplastic Breast Reconstruction

Is Using Closed Incision Negative Pressure Therapy in Reconstructive and Oncoplastic Breast Surgery Helpful in Reducing Skin Necrosis?

Contact Info

Product

Resources

About