title: Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis.
abstract: OBJECTIVE
  To evaluate complications after postmastectomy breast reconstruction, particularly in the setting of adjuvant radiotherapy.
  
  
  BACKGROUND
  Most studies of complications after breast reconstruction have been conducted at centers of excellence; relatively little is known about complication rates in irradiated patients treated in the broader community. This information is relevant for decision making in patients with breast cancer.
  
  
  METHODS
  Using the claims-based MarketScan database, we described complications in 14,894 women undergoing mastectomy for breast cancer from 1998 to 2007 and who underwent immediate autologous reconstruction (n = 2637), immediate implant-based reconstruction (n = 3007), or no reconstruction within the first 2 postoperative years (n = 9250). We used a generalized estimating equation to evaluate associations between complications and radiotherapy over time.
  
  
  RESULTS
  Wound complications were diagnosed within the first 2 postoperative years in 2.3% of patients without reconstruction, 4.4% patients with implants, and 9.5% patients with autologous reconstruction (P < 0.001). Infection was diagnosed within the first 2 postoperative years in 12.7% of patients without reconstruction, 20.5% with implants, and 20.7% with autologous reconstruction (P < 0.001). A total of 5219 (35%) women received radiation. Radiation was not associated with infection in any surgical group within the first 6 months but was associated with an increased risk of infection in months 7 to 24 in all 3 groups (each P < 0.001). In months 7 to 24, radiation was associated with higher odds of implant removal in patients with implant reconstruction (odds ratio = 1.48; P < 0.001) and fat necrosis in those with autologous reconstruction (odds ratio = 1.55; P = 0.01).
  
  
  CONCLUSIONS
  Complication risks after immediate breast reconstruction differ by approach. Radiation therapy seems to modestly increase certain risks, including infection and implant removal.
authors: *Department of Radiation Oncology, University of Michigan, Ann Arbor, MI †Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX ‡Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI §The Swan Center for Plastic Surgery, Alpharetta, GA ¶Departments of Health Services Research and Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX ||Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX **Department of Plastic Surgery, Baylor College of Medicine, Houston, TX. Dr Alderman is in private practice in Alpharetta, GA.
authors: Reshma
authors: R
authors: Jagsi
authors: Jing
authors: J
authors: Jiang
authors: Adeyiza O
authors: AO
authors: Momoh
authors: Amy
authors: A
authors: Alderman
authors: Sharon H
authors: SH
authors: Giordano
authors: Thomas A
authors: TA
authors: Buchholz
authors: Lori J
authors: LJ
authors: Pierce
authors: Steven J
authors: SJ
authors: Kronowitz
authors: Benjamin D
authors: BD
authors: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome