title: The number of operations required for completing breast reconstruction.
abstract: BACKGROUND
  Breast reconstruction often requires multiple surgeries, which demands additional expense and time and is often contrary to the patient's expectation. The aim of this study was to review the number of operations that were needed for completion of breast reconstruction and to determine patient and clinical factors that influenced this number.
  
  
  METHODS
  We retrospectively reviewed the medical records of 254 cases of breast reconstructions (in 185 patients) that were performed between February 2005 and August 2009. We investigated the numbers of operations that were performed for individual case of breast reconstruction and analyzed the influence of variable factors. The purpose of the additional operations was also analyzed.
  
  
  RESULTS
  The mean number of operations per breast was 2.37 (range, 1-9). The mean number of operations for mound creation was 2.24. Factors associated with an increased number of operation were use of an implant, contralateral symmetrization, complications, and nipple reconstruction. Considering the reconstruction method, either the use of a primary implant or the use of free abdominal tissue transfer demonstrated fewer surgeries than the use of an expander implant, and the number of operations using free transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps was less than the number of operations using pedicled transverse rectus abdominis musculocutaneous flaps.
  
  
  CONCLUSIONS
  These data will aid in planning breast reconstruction surgery and will enable patients to be more informed regarding the likelihood of multiple surgeries.
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea; and Aesthetic and Plastic Surgery Institute, University of California, Irvine, Calif.
authors.forename: Jin Sup
authors.initials: JS
authors.lastname: Eom
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea; and Aesthetic and Plastic Surgery Institute, University of California, Irvine, Calif.
authors.forename: Mark Robert
authors.initials: MR
authors.lastname: Kobayashi
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea; and Aesthetic and Plastic Surgery Institute, University of California, Irvine, Calif.
authors.forename: Keyianoosh
authors.initials: K
authors.lastname: Paydar
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea; and Aesthetic and Plastic Surgery Institute, University of California, Irvine, Calif.
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Wirth
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea; and Aesthetic and Plastic Surgery Institute, University of California, Irvine, Calif.
authors.forename: Gregory R D
authors.initials: GR
authors.lastname: Evans