Predicting Complications following Expander/Implant Breast Reconstruction: An Outcomes Analysis Based on Preoperative Clinical Risk
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- 1 June 2008
- journal article
- breast
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 121 (6), 1886-1892
- https://doi.org/10.1097/prs.0b013e31817151c4
Abstract
Background: Complications following postmastectomy reconstruction can cause significant morbidity. The compound effect of individual risk factors on the development of complications following expander/implant reconstruction has not, however, been well delineated. This study evaluated the impact of clinical risk factors to predict complications following postmastectomy expander/implant reconstruction. Methods: From 2003 through 2004, 1170 expander/implant reconstructions were performed at a single center. A prospectively maintained database was reviewed. Variables including age, smoking status, body mass index, history of diabetes, hypertension, chemotherapy and/or radiation, as well as timing and laterality of reconstruction were evaluated. The primary endpoint was the development of a complication; the secondary endpoint was failure of reconstruction. Results: Over the 2 year study period, 1170 expander/implant reconstructions were performed in 884 patients. The odds of developing complications was 2.2 times greater in smokers (p < 0.001) and 2.5 times greater in women over 65 (p = 0.008). Patients who were obese were at nearly two times the odds of having complications (p = 0.02), as were patients with hypertension (p = 0.02). Similarly, the odds of reconstructive failure were five times greater in smokers (p < 0.001). Age was not a significant predictor of reconstructive failure (p = 0.09); yet, failure was nearly seven times greater in obese patients (p < 0.001), and four more times likely in those who were hypertensive (p = 0.005). Conclusions: Smoking, obesity, hypertension, and age over 65 were independent risk factors for perioperative complications following expander/implant breast reconstruction. Smoking, obesity, and hypertension were similarly associated with reconstructive failure. This information can be used to evaluate overall procedural risks and individualize reconstructive options.Keywords
This publication has 14 references indexed in Scilit:
- A Prospective Assessment of Surgical Risk Factors in 400 Cases of Skin-Sparing Mastectomy and Immediate Breast Reconstruction with Implants to Establish Selection CriteriaPlastic and Reconstructive Surgery, 2007
- Risk Factors and Complications in Free TRAM Flap Breast ReconstructionAnnals of Plastic Surgery, 2006
- Survival Effects of Postmastectomy Adjuvant Radiation Therapy Using Biologically Equivalent Doses: A Clinical PerspectiveJNCI Journal of the National Cancer Institute, 2006
- Complications in Smokers After Postmastectomy Tissue Expander/Implant Breast ReconstructionAnnals of Plastic Surgery, 2005
- Infectious Complications following Breast Reconstruction with Expanders and ImplantsPlastic and Reconstructive Surgery, 2003
- Complications in Postmastectomy Breast Reconstruction: Two-Year Results of the Michigan Breast Reconstruction Outcome StudyPlastic and Reconstructive Surgery, 2002
- Complications of Postmastectomy Breast Reconstruction in Smokers, Ex-smokers, and NonsmokersPlastic and Reconstructive Surgery, 2001
- The Premature Removal of Tissue Expanders in Breast ReconstructionPlastic and Reconstructive Surgery, 1999
- Is There Liability With Chemotherapy Following Immediate Breast Reconstruction?Plastic and Reconstructive Surgery, 1996
- Infection Following Breast ReconstructionAnnals of Plastic Surgery, 1989