title: Identification of complications in mastectomy with immediate reconstruction using tissue expanders and permanent implants for breast cancer patients.
abstract: BACKGROUND
  Since complications of postmastectomy breast reconstruction may reduce patient satisfaction, we investigated complications of reconstruction with tissue expanders (TEs), particularly surgical site infections requiring TE/permanent implant (PI) removal.
  
  
  METHODS
  A retrospective review was performed of 234 primary breast cancer patients undergoing 239 postmastectomy breast reconstructions with TEs/PIs from 1997 to 2009. Clinicopathological findings and postoperative complications, particularly infections, were analyzed. Data were analyzed by the Chi-square test and a multivariate logistic regression model. TE infection risk factors considered for model inclusion were excisional biopsy, (neo) adjuvant chemotherapy, lymph node resection, body mass index (BMI), simultaneous bilateral reconstructions, and seroma aspiration.
  
  
  RESULTS
  Removal of TEs/PIs was observed in 15.5% (37/239) of reconstructions, and 18/37 underwent re-reconstructions. Of the 19/37 reconstructions that were not achieved completely, the most frequent reason was TE infection (11 reconstructions). The completion rate was 92% (220/239 reconstructions) and it was significantly higher in reconstructions without TE infection than with infection (96 vs. 54%, p < 0.0001). Patients with BMI ≥ 25 kg/m² and seroma aspiration were more likely to develop TE infections (p = 0.0019, p < 0.001, respectively). By multivariate logistic regression analysis, seroma aspiration was a significant independent risk factor for TE infection (odds ratio 28.75, 95% confidence interval 5.71-40.03, p < 0.0001).
  
  
  CONCLUSIONS
  To improve completion rates of breast reconstruction, prevention of TE infection plays a key role. We should reduce unnecessary seroma aspirations and delay elevation/exercise of the ipsilateral arm.
authors.affiliation: Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan. d-ota@mitsuihosp.or.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ota
authors.affiliation: Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fukuuchi
authors.affiliation: Breast Surgery Clinic, 2-21-43 Takanawa, Minato-ku, Tokyo, 108-0074, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Iwahira
authors.affiliation: Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Surgery, Nippon Kokan Hospital, 1-2-1 Kokandori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0852, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Okamoto
authors.affiliation: Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Nishi
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D015625:Tissue Expansion Devices / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Breast cancer; Complication; Reconstruction; Tissue expander