title: Risk factors for complications following immediate tissue expander based breast reconstruction in Taiwanese population.
abstract: OBJECTIVE
  Breast cancer patients in Asia show considerable disparities from Caucasian patients, such as younger age of onset and lower rates of smoking, obesity, and diabetes. Findings of prior studies regarding risk factors associated with complications in tissue expander may not hold for Asian populations, since most of these studies involved Caucasian patients. In this study, we surveyed risk factors in the Taiwanese population, providing additional evidence about the important differences and discuss the implications for clinical practice.
  
  
  METHODS
  Patients who underwent immediate, two-stage, tissue expander breast reconstruction from December 2008 to August 2014 in the National Taiwan University Hospital, Taipei, Taiwan were included. Follow-up observations of all patients were conducted until December 2014. Complications occurring during the tissue expander stage were evaluated. Multivariate regression modeling was used to identify risk factors for complications.
  
  
  RESULTS
  A total of 246 consecutive, immediate, smooth round tissue expander placements were performed for breast reconstruction. The most common complication was skin necrosis (4.9%), followed by wound dehiscence (4.1%). In the multivariate model, body mass index (BMI) ≥ 24 kg/m2was the only risk factor that reached statistical significance (odds ratio: 2.41, 95% confidence interval: 1.17-4.96).
  
  
  CONCLUSIONS
  We provided evidence that racial disparities have an impact on the risk factors for complications associated with tissue expander breast reconstruction. BMI≥24 kg/m2was the only risk factor significantly associated with complications. Clinically, BMI≥24 kg/m2, rather than the standard definition of obesity (BMI > 30 kg/m2), may be a more suitable cutoff point for risk in patients of Asian ethnicity.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Che-Wei
authors.initials: CW
authors.lastname: Chang
authors.affiliation: Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Hao-Chih
authors.initials: HC
authors.lastname: Tai
authors.affiliation: Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Nai-Chen
authors.initials: NC
authors.lastname: Cheng
authors.affiliation: Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, Taipei Medical University Hospital and College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Wei-Tang
authors.initials: WT
authors.lastname: Li
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.affiliation: Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, Taipei Medical University Hospital and College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: hfchien@h.tmu.edu.tw.
authors.forename: Hsiung-Fei
authors.initials: HF
authors.lastname: Chien
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D018427:Breast Implants; D001943:Breast Neoplasms / Q000628:therapy; D004358:Drug Therapy; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis / Q000453:epidemiology / Q000208:ethnology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000208:ethnology; D011878:Radiotherapy; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000208:ethnology; D013624:Taiwan; D015625:Tissue Expansion Devices / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Asia population; Breast reconstruction; Complications; Racial disparity; Risk factor; Tissue expander