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Timing Of Microsurgical Breast Reconstruction Is Not A Risk Factor For Post-Operative Complications
Hao-Jun J. Chong, M.D.1, Ravi F. Sood, M.D.1, Seung Won Chung, B.S.2, Alexander J. Gougoutas, M.D.1, David W. Mathes, M.D.3.
1University of Washington, Seattle, WA, USA, 2Wayne State University, Detroit, MI, USA, 3University of Colorado, Denver, CO, USA.

PURPOSE
We sought to determine whether an association exists between the timing of microsurgical breast reconstruction and the development of post-operative complications.
METHODS
We conducted a retrospective cohort study enrolling all patients undergoing DIEP breast reconstruction from March 2010−March 2013. The primary exposure was timing of reconstruction, classified as delayed, immediate, or delayed-immediate (tissue expander placement at mastectomy with interval DIEP reconstruction). The primary outcome was the development of any breast-site, abdominal-site, or systemic complication. To control for confounders, we performed a Poisson multivariate regression with the following covariates: age, BMI, diabetes, smoking, chemoradiation, operative length, mastectomy type, and laterality of reconstruction (unilateral vs. bilateral).
RESULTS
Of 316 women enrolled (mean age 49±9 years), 163 (52%) had delayed reconstruction, 76 (24%) immediate, and 77 (24%) delayed-immediate. Overall, 210 (66%) experienced at least one complication, which varied significantly by timing, with 66% for delayed, 78% for immediate, and 56% for delayed-immediate (p=0.017). However, after adjusting for potential confounders, there was no significant association between the timing of reconstruction and the development of post-operative complications (p=0.14). The adjusted relative risk of complications versus delayed reconstruction was 1.05 for immediate reconstruction (95% CI: 0.84–1.32) and 0.82 for delayed-immediate reconstruction (95% CI: 0.64–1.06).
CONCLUSIONS
Although patients undergoing immediate microsurgical breast reconstruction appear to experience more post-operative complications than those undergoing delayed or delayed-immediate reconstruction, this is explained by patient characteristics rather than timing of surgery. Our data suggest that the timing of microsurgical breast reconstruction does not significantly alter the risk of post-operative complications.


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