title: Diminishing relative contraindications for immediate breast reconstruction.
abstract: BACKGROUND
  The rise in U.S. immediate breast reconstruction over the past decade may reflect greater patient awareness or expanding use in women not previously offered reconstruction. The purpose of the current study was to determine whether reconstruction in high-risk surgical and oncologic patients was a factor contributing to increased reconstruction rates, specifically using prosthetic techniques.
  
  
  METHODS
  Information from a cohort of mastectomy patients from 2001 to 2012 was extracted from an institutional database, including the presence of high-risk surgical or oncologic features (age over 60 years old, body mass index greater than 30, comorbidities, smoking, advanced disease, and prior or postmastectomy radiotherapy). Trends in reconstruction rates and method were analyzed with Poisson regression. Reconstructive success was defined as tissue expander exchange to a permanent implant or autologous techniques without vascular complications.
  
  
  RESULTS
  A total of 10,299 patients were included. Immediate reconstruction in high-risk patients increased from 45.0 to 70.7 of 100 mastectomies (p < 0.01). Although autologous use increased only for obese patients (p < 0.01), prosthetic techniques were greater for all high-risk features (p < 0.01). Reconstructive success was 88 percent in high-risk patients; however, the number of failures was greater, including tissue expander loss, implant explantation, and flap vascular complications.
  
  
  CONCLUSIONS
  The proportion of high-risk patients undergoing immediate breast reconstruction-specifically using prosthetic-based techniques-increased over the study period. Increased complications may be a tradeoff for the benefits of reconstruction. These findings support diminishing relative contraindications for immediate breast reconstruction at a tertiary cancer center.
  
  
  METHODS
  Risk, IV.
authors.affiliation: New York, N.Y. From the Plastic and Reconstructive Surgical Service and the Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Albornoz
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Gina
authors.initials: G
authors.lastname: Farias-Eisner
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018427:Breast Implants / Q000706:statistics & numerical data / Q000639:trends; D000075202:Contraindications; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D008408:Mastectomy; D008875:Middle Aged; D009519:New York City; D009765:Obesity; D018579:Patient Selection; D016012:Poisson Distribution; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012907:Smoking; D013997:Time Factors