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True Incidence of All Complications following Immediate and Delayed Breast Reconstruction

Sullivan, Stephen R. M.D.; Fletcher, Derek R. D. M.D.; Isom, Casey D. M.D.; Isik, F Frank M.D.

Plastic and Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - p 19-28
doi: 10.1097/PRS.0b013e3181774267

Background: Improved self-image and psychological well-being after breast reconstruction are well documented. To determine methods that optimized results with minimal morbidity, the authors examined their results and complications based on reconstruction method and timing.

Methods: The authors reviewed all breast reconstructions after mastectomy for breast cancer performed under the supervision of a single surgeon over a 6-year period at a tertiary referral center. Reconstruction method and timing, patient characteristics, and complication rates were reviewed.

Results: Reconstruction was performed on 240 consecutive women (94 bilateral and 146 unilateral; 334 total reconstructions). Reconstruction timing was evenly split between immediate (n = 167) and delayed (n = 167). Autologous tissue (n = 192) was more common than tissue expander/implant reconstruction (n = 142), and the free deep inferior epigastric perforator was the most common free flap (n = 124). The authors found no difference in the complication incidence with autologous reconstruction, whether performed immediately or delayed. However, there was a significantly higher complication rate following immediate placement of a tissue expander when compared with delayed reconstruction (p = 0.008). Capsular contracture was a significantly more common late complication following immediate (40.4 percent) versus delayed (17.0 percent) reconstruction (p < 0.001; odds ratio, 5.2; 95 percent confidence interval, 2.3 to 11.6).

Conclusions: Autologous reconstruction can be performed immediately or delayed, with optimal aesthetic outcome and low flap loss risk. However, the overall complication and capsular contracture incidence following immediate tissue expander/implant reconstruction was much higher than when performed delayed. Thus, tissue expander placement at the time of mastectomy may not necessarily save the patient an extra operation and may compromise the final aesthetic outcome.

Seattle, Wash.

From The Polyclinic and the Division of Plastic and Reconstructive Surgery, University of Washington.

Received for publication June 20, 2007; accepted November 21, 2007.

Presented at the American College of Surgeons Annual Meeting of the Washington State Chapter, in Sunriver, Oregon, June 18 through 21, 2006.

Disclosure: None of the authors has any commercial associations, supporting funds, or financial disclosures.

F. Frank Isik, M.D., The Polyclinic, 1145 Broadway, Seattle, Wash. 98122,

©2008American Society of Plastic Surgeons