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Identifying Risk Factors for Elective Revisions after Breast Reconstruction
Casey Zhang, BS
Shayan M. Sarrami, MD
Vivian Wang, BA
Pooja Reddy, BA
Carolyn De La Cruz, MD
University of Pittsburgh
2024-01-14
Presenter: Shayan M. Sarrami
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. 100% of the work on this project is original work by the authors.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
There is an increase in women seeking breast reconstruction following mastectomies, and a rise in revision surgeries to provide cosmetically acceptable results. It is critical that plastic surgeons give appropriate education regarding patient's reconstructive planning. This study asses the rate of cosmetic revisions required after breast reconstruction and the associated risk factors.
Methods:
A retrospective review included patients undergoing breast reconstruction with a single surgeon from 2012–2017 following mastectomy. Revision surgery was considered any elective procedure not included in the initial reconstructive plan. Univariate analysis evaluated associated surgical and demographic risk factors.
Results:
Our cohort included 412 breast reconstruction patients, seventy-five (18.2%) received a revision surgery. There was no significant difference found between abdominally based flaps, latissimus flap with an implant, or implant-based reconstruction (26.2% vs 20.5% vs 16.3%, respectively). There was significance when considering the total number of cosmetic surgeries, planned and unplanned. Implants had the most procedures (2.06 operations), followed by latissimus flaps (1.68 operations), and finally abdominally based flaps (1.21 operations, p =0.000). Logistic regression showed prior radiation was associated with increased likelihood of revision surgery (OR 1.85, p=0.025). Subgroup analysis of patients who received abdominally based free flaps showed significant association between increased preoperative BMIs and revisions (p=0.043).
Conclusion:
Additional cosmetic surgeries are necessary for some breast reconstruction patients. Pre-operative factors, specifically radiation and BMI, were associated with increased revision rates. In our cohort, the type of reconstruction was not predictive of revision. This knowledge base provides informed patient decision-making and improved surgical planning.
