Complications in Post-mastectomy Immediate Breast Reconstruction: A Ten-year Analysis of Outcomes

Joanna Ck Mak; Ava Kwong

doi:10.1016/j.clbc.2019.12.002

Complications in Post-mastectomy Immediate Breast Reconstruction: A Ten-year Analysis of Outcomes

Clin Breast Cancer. 2020 Oct;20(5):402-407. doi: 10.1016/j.clbc.2019.12.002. Epub 2020 May 23.

Authors

Joanna Ck Mak¹, Ava Kwong²

Affiliations

¹ Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
² Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Electronic address: avakwong@hku.hk.

PMID: 32665188
DOI: 10.1016/j.clbc.2019.12.002

Abstract

Introduction: Immediate breast reconstruction offers cosmetic and psychological advantages post-mastectomy. There are various options of reconstruction, and this study aims to evaluate the associated complications.

Patients and methods: This is a single-center retrospective study analyzing data from January 1, 2008 to December 31, 2017 for immediate breast reconstruction procedures post-mastectomy performed at an academic breast unit. Procedures included expander and implant insertion, latissimus dorsi, pedicle transverse rectus abdominis musculocutaneous (TRAM), free TRAM, and deep inferior epigastric perforator. Complications and reoperative complications (defined as those requiring a reoperation within the first 30-day period), and associated risk factors were investigated using separate logistic regressions, and odds ratios (ORs) were calculated.

Results: A total of 243 post-mastectomy immediate breast reconstruction procedures and complications rates were analyzed. The overall complication rate was 27.6%, comprised mainly of reconstruction-specific complications such as post-TRAM hernia or bulges, fat necrosis, and implant capsular contracture and leakage. The rate of reoperative complications was relatively low at 6.6%. The flap failure rate was similar between expander/implant reconstruction and autologous reconstruction methods at 3.3% and 5.6%, respectively (P = .60). Logistic regression identified significantly higher risks associated with diabetes mellitus (OR, 5.21; P = .022), obesity (OR, 5.80; P = .016), and free pedicle autologous reconstruction (OR, 3.975; P = .046) for reoperative complications.

Conclusion: Different methods of immediate breast reconstruction post-mastectomy are feasible and safe. However, patient variables and procedure choice should be taken into consideration when counseling patients on reconstructive options, as they are strong predictors for postoperative complications.

Keywords: Autologous flap reconstruction; Breast cancer; Implant reconstruction; Mastectomy; Morbidity.

Publication types

Clinical Trial

MeSH terms

Adult
Breast Neoplasms / pathology
Breast Neoplasms / surgery*
Female
Follow-Up Studies
Humans
Mammaplasty / adverse effects*
Mammaplasty / methods
Mammaplasty / statistics & numerical data
Mastectomy / adverse effects*
Mastectomy / methods
Mastectomy / statistics & numerical data
Middle Aged
Postoperative Complications / diagnosis
Postoperative Complications / etiology
Prognosis
Retrospective Studies
Risk Factors
Time Factors