PURPOSE:
Complications following postmastectomy reconstruction can cause significant morbidity, including the delay of subsequent antineoplastic therapies. The compound effect of individual risk factors on the development of complications following expander/implant reconstruction has not, however, been well delineated. The purpose of this study was to evaluate the impact of clinical risk factors in order to predict the likelihood of complications following postmastectomy expander/implant reconstruction.
METHODS:
From January 2003 to December 2004, 1166 expander/implant reconstructions were performed at a single center. A prospectively-maintained database was reviewed. Clinical variables including: smoking status, BMI, history of diabetes and/or hypertension, history of chemotherapy and/or irradiation, and timing of reconstruction were recorded. The primary outcome measure was the development of peri-operative complications. Multivariate analysis was performed using logistic regression modeling
RESULTS:
1166 expander/implant reconstructions in 880 patients were performed. The overall rate of complications was 14.9%; the most common complication was mastectomy flap necrosis. Complications were 2.4 times more likely in smokers [OR 2.4, 95%CI (1.5-3.8)]; and, 1.6 times more likely in obese patients [OR 1.6, (1.0-2.7)]. Neither a history of diabetes and/or hypertension [OR 0.8, (0.2-3.8); OR 1.5, (0.9-2.6)], nor the timing of reconstruction [OR 0.9, (0.3-2.8)], nor the receipt of neoadjuvant chemo/radiotherapy [OR 0.8, (0.6-1.3); OR 1.2, (0.6-2.2)] were predictive of complications.
CONCLUSION:
Smoking and obesity are independent risk factors for complications following expander/implant breast reconstruction. There is no multiplicative effect between these variables. A thorough assessment of pre-operative clinical variables can be used to evaluate overall procedural risks and individualize reconstructive options