Complications analysis of 266 immediate breast reconstructions

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Summary

The purpose of this study was to describe the complications of immediate breast reconstruction, to compare their rates with respect to the surgical procedure and to patient's characteristics, in order to improve surgical indications and patient information.

We carried out a retrospective study of 266 immediate breast reconstructions (249 women) over a 12-year period (latissimus dorsi myocutaneous flap with implant 61%, autologous latissimus dorsi myocutaneous flap 15%, subpectoral implant 24%). Mean age was 48 and the median follow-up was seven years (2–14).

The overall complication rate was 49% (128), and there were 10 reconstruction failures. The most frequent complications were dorsal seroma 26% (70), capsular contracture 10% (27), skin necrosis 8.3% (22), and haematoma 5.6% (15). The complication rate for immediate breast reconstruction with implant alone (39%) was lower than that associated with latissimus dorsi with or without implant (51%), but the difference was not significant (Chi-square: p = 0.07). The risk factors for complications were smoking (skin necrosis, Fisher: p = 0.02), obesity (infection, Fisher: p = 0.004), and radiotherapy (capsular contracture, Chi-square: p = 2.6 × 10−5). Smoking was found as the only risk factor of reconstruction failure (Fisher: p = 0.015). Capsular contractures were more frequent when implants were used alone (25%) as well as when used along with a flap (6.8%) (Chi-square: p =2 × 10−5). Infections were also higher in the non-flap group than in the flap group (Fisher: p = 0.02).

In our opinion, latissimus dorsi myocutaneous flap with or without an implant is a good compromise between complication risk and necessity of good cosmetic result requirement. These results have led us to delay or contraindicate reconstruction in the case of obesity or heavy smoking. In the case of probable post-operative radiotherapy, we prefer to delay the breast reconstruction.

Section snippets

Patients

This study was a retrospective review of charts drawn up between January 1, 1990 and December 31, 2002, all women who underwent a mastectomy and a breast reconstructive procedure during a single anaesthetic were included. The only exclusion criterion was for patients who underwent an extensive mastectomy for local advanced cancer and required a covering procedure to close large skin defects.

Definitions and methods

We consider bilateral immediate breast reconstruction to be two distinct reconstructions, because tumour

Results

Patient characteristics, tumour's status, associated treatments and surgical procedures for the 266 immediate breast reconstructions are presented in Table 1.

Mean age was 48 and the median follow-up was seven years. The percentage of smokers was 17% as was the percentage of women who had a Body Mass Index >25. Ductal carcinoma in situ was the main histology accounting for 68% of the cases. The mastectomy was performed for a primary treatment in 86% of the cases. Chemotherapy and radiotherapy

Discussion

With 266 immediate breast reconstructions our study is one of the largest series to be published.7, 10, 11, 12, 13, 14, 15 The mean follow-up is long enough (seven years) for late-onset complications to be taken into consideration. The mean age of the patients (48 years) reflects a young population as well as delayed reconstruction patients.16 We attribute the 4% higher rate of left side cancer cases to chance. Most of the patients had a T0 or T1 in situ ductal carcinoma, were N0 before surgery

Acknowledgements

We wish to special thank Véronique Brouste from the Bergonié Institute department of Biostatistics and Clinical Research.

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    Presented at the 49th Congress of French Society of Plastic Surgery (November 2004).

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