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Immediate Versus Delayed Breast Reconstruction Following Mastectomy: Complications And Patient Selection
Authors: Stephen Lopez, Rachel Michael, Douglas Wagner
Summa plastic surgery residency
2015-03-14
Presenter: stephen lopez
Affidavit:
The author Stephen Lopez has performed >90% of the research and writing of the above abstract.
Director Name: Douglas Wagner
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: There are many studies comparing cost, aesthetics and psychosocial implications in regards to immediate versus delayed breast reconstruction after mastectomy, but paucity of information regarding complication, revision rates and patient selection. This study looks at these variables.
Methods: Retrospective analysis of 290 breast reconstructions by a single surgeon from 2010-2014. Reconstruction comparison was achieved with Student's t-test/Pearson chi-square, or Fisher's exact. Complications and revision rates were compared. Continuous variables analyzed using logistical regression and p-values attained.
Results: 186 charts reviewed over a 4 year period with a mean follow up of 15.4 months. Majority were performed for stage 0 cancer (n=104, 55%). Greater number of immediate reconstructions (n= 223) versus delayed (n= 67) with a greater number of tissue expander/implant reconstruction (n= 230) versus autologous reconstruction (n= 60; pedicle TRAM / latissimus dorsi flaps). Statistical analysis showed no difference in overall complication with immediate versus delayed reconstruction (p=0.8; 95% CI=0.52, 1.66) and further subgroups: implant/TE (p=0.507; CI=0.57, 3.12) and autologous (p=0.10; CI=0.84, 6.88). There was a significant difference found for prior breast conservative therapy (BCT)/radiation and current smoker (<3months) (p=0.026; CI=1.09, 4.62 & p=0.002; CI1.39, 4.92 respectively) There was a significant difference noted in the need for subsequent revision rates in the immediate implant group (p <0.001).
Conclusion: Immediate and delayed reconstruction can be performed with no difference in complications, however smoking within 3 months of reconstruction or prior history of BCT/radiation may lead to higher complication rates. Immediate implant/TE reconstruction was found to lead to higher revision rates.
