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.
McCarthy
Colleen M
CM
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.
Mehrara
Babak J
BJ
Riedel
Elyn
E
Davidge
Kristen
K
Hinson
Akili
A
Disa
Joseph J
JJ
Cordeiro
Peter G
PG
Pusic
Andrea L
AL
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