A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications.
BACKGROUND
Multiple prior reports are conflicted regarding the true incidence of complications following implant-based breast reconstruction. A review of a single surgeon's extensive experience with tissue expander/implant reconstruction provides the opportunity to critically evaluate outcomes in a uniformly treated patient population. The objective of this study was to analyze the development of early complications in patients following two-stage implant breast reconstruction.


METHODS
A review of all tissue expander/implant reconstructions performed by a single surgeon over the 12-year period from July of 1992 to June of 2004 was performed. A prospectively maintained database was analyzed with respect to reconstructive and early complication data on 1522 reconstructions in 1221 patients. Early complications were defined as those occurring 12 months or less from initiation of reconstruction.


RESULTS
The overall rate of early complications was 5.8 percent; the rate of premature expander removal was 2.7 percent. The most common complication was infection (2.5 percent). The incidence of complications after tissue expander insertion (8.5 percent) was significantly higher than that after the exchange procedure (2.7 percent). The rate of complications was significantly higher in patients with a history of preoperative chest wall irradiation. There was no difference in the incidence of complications in patients who were expanded during chemotherapy and those who were not.


CONCLUSIONS
Tissue expander/implant reconstruction is a safe, reliable method of reconstruction with minimal early complications. Early complications are more common after expander insertion. Chemotherapy administered during tissue expansion does not increase the rate of complications. The rate of complications, although higher in previously irradiated patients, remains low.
Cordeiro
Peter G
PG
New York, N.Y. From the Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.
McCarthy
Colleen M
CM
D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D018427:Breast Implants; D003131:Combined Modality Therapy; D006801:Humans; D008408:Mastectomy; D011183:Postoperative Complications; D011446:Prospective Studies; D015625:Tissue Expansion Devices