Plastic and Reconstructive Surgery

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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31817151c4
Breast: Original Articles

Predicting Complications following Expander/Implant Breast Reconstruction: An Outcomes Analysis Based on Preoperative Clinical Risk

McCarthy, Colleen M. M.D., M.S.; Mehrara, Babak J. M.D.; Riedel, Elyn M.A.; Davidge, Kristen M.D.; Hinson, Akili M.D.; Disa, Joseph J. M.D.; Cordeiro, Peter G. M.D.; Pusic, Andrea L. M.D., M.H.S.

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Background: Complications following postmastectomy reconstruction can cause significant morbidity. The compound effect of individual risk factors on the development of complications following expander/implant reconstruction has not, however, been well delineated. This study evaluated the impact of clinical risk factors to predict complications following postmastectomy expander/implant reconstruction.

Methods: From 2003 through 2004, 1170 expander/implant reconstructions were performed at a single center. A prospectively maintained database was reviewed. Variables including age, smoking status, body mass index, history of diabetes, hypertension, chemotherapy and/or radiation, as well as timing and laterality of reconstruction were evaluated. The primary endpoint was the development of a complication; the secondary endpoint was failure of reconstruction.

Results: Over the 2 year study period, 1170 expander/implant reconstructions were performed in 884 patients. The odds of developing complications was 2.2 times greater in smokers (p < 0.001) and 2.5 times greater in women over 65 (p = 0.008). Patients who were obese were at nearly two times the odds of having complications (p = 0.02), as were patients with hypertension (p = 0.02). Similarly, the odds of reconstructive failure were five times greater in smokers (p < 0.001). Age was not a significant predictor of reconstructive failure (p = 0.09); yet, failure was nearly seven times greater in obese patients (p < 0.001), and four more times likely in those who were hypertensive (p = 0.005).

Conclusions: Smoking, obesity, hypertension, and age over 65 were independent risk factors for perioperative complications following expander/implant breast reconstruction. Smoking, obesity, and hypertension were similarly associated with reconstructive failure. This information can be used to evaluate overall procedural risks and individualize reconstructive options.

©2008American Society of Plastic Surgeons


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