Post-mastectomy reconstruction: A risk-stratified comparative analysis of outcomes

Abstract Introduction Although breast reconstruction following mastectomy plays a role in the psychological impact of breast cancer, only one in three women undergo reconstruction. Few multi-institutional studies have compared complication profiles of reconstructive patients to non-reconstructive. M...

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Published inBreast (Edinburgh) Vol. 22; no. 6; pp. 1072 - 1080
Main Authors Saha, Sujata, Davila, Armando A, Ver Halen, Jon P, Jain, Umang K, Hansen, Nora, Bethke, Kevin, Khan, Seema A, Jeruss, Jacqueline, Fine, Neil, Kim, John Y.S
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier Ltd 01.12.2013
Subjects
Breast Neoplasms - surgery
Breast reconstruction
Comorbidity
Complication
Female
Hematology, Oncology and Palliative Medicine
Humans
Implant
Incidence
Mammaplasty
Mastectomy, Simple
Middle Aged
Outcomes
Postoperative Complications - epidemiology
Propensity Score
Registries
Retrospective Studies
Risk Factors
Submuscular
Tissue expander
Submuscular
Complication
Tissue expander
Implant
Breast reconstruction
Outcomes
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Summary:Abstract Introduction Although breast reconstruction following mastectomy plays a role in the psychological impact of breast cancer, only one in three women undergo reconstruction. Few multi-institutional studies have compared complication profiles of reconstructive patients to non-reconstructive. Methods Using the National Surgical Quality Improvement database, all patients undergoing mastectomy from 2006 to 2010, with or without reconstruction, were identified and risk-stratified using propensity scored quintiles. The incidence of complications and comorbidities were compared. Results Of 37,723 mastectomies identified, 30% received immediate breast reconstruction. After quintile matching for comorbidities, complications rates between reconstructive and non-reconstructives were similar. This trend was echoed across all quintiles, except in the sub-group with highest comorbidities. Here, the reconstructive patients had significantly more complications than the non-reconstructive (22.8% versus 7.0%, p  < 0.001). Conclusion Immediate breast reconstruction is a well-tolerated surgical procedure. However, in patients with high comorbidities, surgeons must carefully counterbalance surgical risks with psychosocial benefits to maximize patient outcomes. Level of evidence Level 3
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ISSN:0960-9776
1532-3080
DOI:10.1016/j.breast.2013.09.010