title: Once is Rarely Enough: A Population-Based Study of Reoperations after Postmastectomy Breast Reconstruction.
abstract: OBJECTIVE
  Postmastectomy breast reconstruction (PMBR) aims to surgically restore a breast mound following mastectomy. However, additional surgical procedures after PMBR can lead to increased postsurgical morbidity and healthcare utilization. The primary purpose of our study was to determine the overall population-based reoperation rates following PMBR in Ontario, Canada.
  
  
  METHODS
  We conducted a population-based retrospective cohort study that included women aged 18-65 years who underwent a prophylactic or therapeutic mastectomy with immediate or delayed PMBR between April 1, 2002 and March 31, 2008. Reoperations to the breast or donor site used for reconstruction were identified using the Ontario Health Insurance Plan billing codes submitted by general or plastic surgeons. Reoperations were categorized as anticipated, unanticipated major, unanticipated minor, or oncologic. Patients were followed from the date of their PMBR to March 31, 2013, or death.
  
  
  RESULTS
  Overall, 3972 women underwent PMBR between April 1, 2002 and March 31, 2008. Among them, 3504 (88%) underwent at least one reoperation during an average follow-up of 5.1 years. The median number of procedures per patient was two (mean 2.4, range 0-26). One of ten patients had three or more unanticipated major reoperations during the follow-up period.
  
  
  CONCLUSIONS
  Our results provide the first long-term population-level data on the current state of PMBR reoperation rates. The results from this study will inform patient-physician surgical decision-making and provide quantitative expectations of morbidity related to PMBR.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada, amanda.roberts@mail.utoronto.ca.
authors.forename: Amanda
authors.initials: A
authors.lastname: Roberts
authors.forename: Nancy
authors.initials: N
authors.lastname: Baxter
authors.forename: Ximena
authors.initials: X
authors.lastname: Camacho
authors.forename: Cindy
authors.initials: C
authors.lastname: Lau
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult