title: A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria.
abstract: BACKGROUND
  Although attempts have been made to identify the risk factors leading to complications after combined skin-sparing mastectomy and immediate prosthetic breast reconstruction, hardly any criteria are available to preoperatively distinguish patients in whom such an eventful postoperative course may be expected. Therefore, the authors wanted to establish which factors increase the risk of surgical complications to such a level as to adjust their indications for immediate breast reconstruction after skin-sparing mastectomy.
  
  
  METHODS
  The authors prospectively studied the clinical relevance of six patient-related and nine procedure-related characteristics as potential risk factors for a complicated surgical outcome in 400 combined procedures in 309 patients by univariate and multivariate logistic regression analysis. Risk factors that proved significantly correlated with loss of implant by both analyses were accepted as clinical selection criteria that distinguish potential candidates with an unacceptably high risk of such loss.
  
  
  RESULTS
  Mild complications occurred significantly more often in patients who were older than the mean age of 43 years and in breasts that were more than average sized or operated on by a fellow in oncologic surgery. Implants were lost significantly more often in patients who were obese or smoked and in breasts that were more than average sized.
  
  
  CONCLUSIONS
  The clinically relevant increase of risk of implant loss should lead to reluctance to perform combined skin-sparing mastectomy and immediate prosthetic breast reconstruction in obese patients who smoke (32 percent loss) and in those with more than average sized breasts (27 percent loss).
authors.affiliation: Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam NL-1066 CX, The Netherlands. l.woerdeman@nki.nl
authors.forename: Leonie A E
authors.initials: LA
authors.lastname: Woerdeman
authors.forename: J Joris
authors.initials: JJ
authors.lastname: Hage
authors.forename: Marjolein M I
authors.initials: MM
authors.lastname: Hofland
authors.forename: Emiel J Th
authors.initials: EJ
authors.lastname: Rutgers
mesh_terms: D001940:Breast / Q000033:anatomy & histology; D018427:Breast Implants; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D009765:Obesity / Q000150:complications; D009929:Organ Size; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects