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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.

Plastic and Reconstructive Surgery: June 2008 - Volume 121 - Issue 6 - p 1886-1892
doi: 10.1097/PRS.0b013e31817151c4

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.

New York, N.Y.

From the Plastic and Reconstructive Surgery Service, Department of Surgery, and the Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center.

Received for publication May 16, 2007; accepted August 23, 2007.

Presented at the 85th Annual Meeting of the American Association of Plastic Surgeons, in Hilton Head, South Carolina, May 6 through 9, 2006.

Colleen M. McCarthy, M.D., M.S.; Plastic and Reconstructive Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; 1275 York Avenue, Room C-1193; New York, N.Y. 10021;

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

©2008American Society of Plastic Surgeons