Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk.
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.
Colleen M
CM
McCarthy
Babak J
BJ
Mehrara
Elyn
E
Riedel
Kristen
K
Davidge
Akili
A
Hinson
Joseph J
JJ
Disa
Peter G
PG
Cordeiro
Andrea L
AL
Pusic
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015625:Tissue Expansion Devices; D016896:Treatment Outcome