title: A comparison of surgical complications between immediate breast reconstruction and mastectomy: the impact on delivery of chemotherapy--an analysis of 391 procedures.
abstract: OBJECTIVE
  To compare the postoperative complications after immediate breast reconstruction (IBR) versus mastectomy alone and to examine the impact on the delivery of chemotherapy.
  
  
  METHODS
  In this prospective series, there were 391 consecutive women who underwent mastectomy (243 mastectomy alone and 148 mastectomy and IBR). The outcome measures were complications (within 3 months after surgery) and time to adjuvant chemotherapy.
  
  
  RESULTS
  Compared to the IBR group, patients in the mastectomy alone group were significantly older (P < 0.0001), smokers (P = 0.007) and less likely to have had previous radiation or lumpectomy (P < 0.0001). Overall, the complication rate was significantly greater in the IBR group than mastectomy alone (27.0% vs. 15.6%, P = 0.009). Univariate analyses revealed that mastectomy with IBR [odds ratio (OR) = 2, 95% confidence interval (CI) 1.21-2.30]; bilateral procedure (OR = 1.84, 95% CI 1.07-3.16); previous radiotherapy (OR = 2.4, 95% CI 1.29-4.47); and previous lumpectomy (OR = 1.84, 95% CI 1.11-3.03) were significant predictors of increased complications. With multivariable analysis, none of these variables were significantly associated with increased complications. 106 patients received adjuvant chemotherapy; median time from mastectomy to chemotherapy was 6.8 (0.71-15) weeks in the mastectomy alone group (n = 96) compared to 8.5 (6.3-11) weeks in the IBR group (n = 10) (P = 0.01).
  
  
  CONCLUSIONS
  Although the incidence of overall and major postoperative complications was higher after IBR than mastectomy alone, there were no significant relationships in the multivariable analysis. IBR was associated with a modest increase in time to chemotherapy that was statistically but not clinically significant.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada. Toni.zhong@uhn.on.ca
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.forename: Stefan O P
authors.initials: SO
authors.lastname: Hofer
authors.forename: David R
authors.initials: DR
authors.lastname: McCready
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Jacks
authors.forename: Francis E
authors.initials: FE
authors.lastname: Cook
authors.forename: Nancy
authors.initials: N
authors.lastname: Baxter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D016462:Mammaplasty; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015233:Models, Statistical; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents