title: Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction.
abstract: BACKGROUND
  Expander/implant breast reconstruction is a common approach to breast reconstruction. Although several studies evaluate risk factors for complications during the overall reconstructive process, no studies currently evaluate risk factors by stage of reconstruction. This information is important, as it can help guide physician and patient decision making.
  
  
  METHODS
  This is a retrospective review of the records of 876 patients who underwent expander/implant breast reconstruction. Average follow-up time was 42 months. Multivariate analysis and odds ratios were used to calculate the significance of the variables of interest and to compare the risk of complications attributable to each of the independent variables during each stage of the procedure.
  
  
  RESULTS
  During the expander stage, body mass index greater than 30 kg/m had the strongest effect on the development of complications leading to explantation/conversion to flap (OR, 3.07). During the permanent implant stage, history of prereconstruction irradiation had the strongest association with the development of complications leading to explantation/conversion to flap (OR, 3.45). The only risk factors that had a statistically significant effect on the development of complications during both stages were age older than 50 years, smoking within the past month, and a history of premastectomy or postmastectomy radiation therapy.
  
  
  CONCLUSIONS
  The results of this study indicate that the risk factors for complications during expander/implant breast reconstruction differ during each stage of the procedure. The individual impact of risk factors must be considered within the context of each patient's oncologic and surgical needs so that surgeons and patients may make more informed decisions toward their goal of a successful breast reconstruction.
  
  
  METHODS
  Risk, III.
authors.affiliation: Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine.
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Hirsch
authors.forename: Akhil K
authors.initials: AK
authors.lastname: Seth
authors.forename: John Y S
authors.initials: JYS
authors.lastname: Kim
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Dumanian
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mustoe
authors.forename: Robert D
authors.initials: RD
authors.lastname: Galiano
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000503:physiopathology* / Q000601:surgery; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D015625:Tissue Expansion Devices / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult