title: Post-mastectomy reconstruction: a risk-stratified comparative  analysis of outcomes.
abstract: BACKGROUND
  Although breast reconstruction following mastectomy plays a role in the psychological impact of breast cancer, only one in three women undergo reconstruction. Few multi-institutional studies have compared complication profiles of reconstructive patients to non-reconstructive.
  
  
  METHODS
  Using the National Surgical Quality Improvement database, all patients undergoing mastectomy from 2006 to 2010, with or without reconstruction, were identified and risk-stratified using propensity scored quintiles. The incidence of complications and comorbidities were compared.
  
  
  RESULTS
  Of 37,723 mastectomies identified, 30% received immediate breast reconstruction. After quintile matching for comorbidities, complications rates between reconstructive and non-reconstructives were similar. This trend was echoed across all quintiles, except in the sub-group with highest comorbidities. Here, the reconstructive patients had significantly more complications than the non-reconstructive (22.8% versus 7.0%, p < 0.001).
  
  
  CONCLUSIONS
  Immediate breast reconstruction is a well-tolerated surgical procedure. However, in patients with high comorbidities, surgeons must carefully counterbalance surgical risks with psychosocial benefits to maximize patient outcomes.
  
  
  METHODS
  Level 3.
authors.forename: Dujata
authors.initials: D
authors.lastname: Saha
authors.forename: Armando A
authors.initials: AA
authors.lastname: Davila
authors.forename: Jon P
authors.initials: JP
authors.lastname: Ver Halen
authors.forename: Umang K
authors.initials: UK
authors.lastname: Jain
authors.forename: Nora
authors.initials: N
authors.lastname: Hansen
authors.forename: Kevin
authors.initials: K
authors.lastname: Bethke
authors.forename: Seema A
authors.initials: SA
authors.lastname: Khan
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jeruss
authors.forename: Neil
authors.initials: N
authors.lastname: Fine
authors.forename: john Y S
authors.initials: jY
authors.lastname: Kim
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty; D015413:Mastectomy, Simple; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors