Complications in post-mastectomy immediate breast reconstruction: a ten-year analysis of outcomes

Abstract

Introduction: Breast reconstruction offers cosmetic and psychological advantages for women who choose to have a mastectomy. Immediate breast reconstruction has been proven to be oncologically safe, although it is associated with increased operative complications when compared to mastectomy alone. This study aims to evaluate the complications of the various options of immediate breast reconstruction. Materials & Methods: This is a single center retrospective study analyzing data from January 1st, 2008 to December 31st, 2017 for immediate breast reconstruction procedures post-mastectomy performed at an academic breast unit. Procedures included expander and implant insertion, latissimus dorsi (LD), pedicle transverse rectus abdominis musculocutaneous (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP) and transverse upper gracilis (TUG) flap reconstruction. Complications, major complications (defined as those requiring rehospitalization and/or reoperation), their respective re-operation rates, and associated risk factors were investigated using separate logistic regressions and odds ratios (OR) were calculated. Results: A total of 243 post-mastectomy immediate breast reconstruction procedures and complications rates were analyzed. The overall complication rate was 23.9%, with over half of complications being post-TRAM hernia or bulges. The rate of major complications was relatively low at 6.6%; the re-operation rate for major complications was 7%. The flap failure rate was similar between expander/implant reconstruction and autologous reconstruction methods at 3.3% and 3.8% respectively (p=0.909). Logistic regression identified significantly higher risks associated with diabetes mellitus (OR 5.21, CI: 1.34-47.28, p=0.022), BMI > 25 (OR 5.80, CI: 1.27-10.05, p=0.016) and free pedicle autologous reconstruction (OR 3.975, CI: 0.08-0.98, p=0.046) for major complications. Conclusion: The different methods of immediate breast reconstruction post-mastectomy are proven feasible and safe. However, patient variables and procedure choice are predictors for postoperative complications and should be taken into consideration when counseling patients on reconstructive options