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Change In Risk Factors Contributing To Major Complications Following Implant Based Breast Reconstruction With Or Without Post-mastectomy Radiation
Paul Durand MD
Neil M. Woody MD MS
Mihir Naik DO
Adekunle Elegbede PhD
Eliana Duraes MD
Suzie B Coopey MD
Jill Dietz MD
Rahul D. Tendulkar MD
Risal Djohan MD
Cleveland Clinic Foundation
2014-03-14
Presenter: Paul Durand, MD
Affidavit:
All the work above has been original work of resident.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Obesity has been commonly implicated in major complications following implant-based reconstruction. Reviewing our data, we found that other factors might contribute to such complications.
Objective: To examine risk factors associated with major complications and reoperations following implant-based breast reconstruction. To examine reasons for reoperation between patients that underwent PMRT and those who did not.
Methods: Patients undergoing immediate, two-stage implant-based breast reconstruction in an eight-year period at a single-tertiary institution were reviewed. Major complications were defined as any blood transfusion, hematoma/seroma requiring reoperation, capsular contracture (Baker III-IV or requiring reoperation), infection requiring home IV antibiotics or implant removal, dehiscence, implant leak, or extrusion.
Results: 593 patients undergoing 785 immediate, two-stage implant-based reconstructions were included, with median follow-up of 6.5 years. Median age 45; median BMI 28.4. 18% hypertension; 3% diabetes; and 17% received PMRT. On multivariate analysis, hypertension (HR 2.64,p=0.0094) and PMRT (HR 1.62,p<0.0001) were significant predictors of major toxicity in the overall cohort. In non-PMRT group, diabetes (HR 2.09,p=0.057) and hypertension (HR 1.64,p=0.09) were of borderline significance. Major complication rates at 5 years were significantly increased with PMRT vs. without PMRT (p<0.0001). While total reoperation rates were significantly higher in the PMRT group, reoperation for cosmetic reasons amongst the non-PMRT group was almost double.
Conclusions: Hypertension and PMRT are the strongest predictors of toxicity following implant-based breast reconstruction. Previously reported risk factors such as age and BMI did not appear to be predictors of major complications. Reoperation due to cosmetic reasons was significantly higher amongst non-XRT patients.
