title: Effect of Noninfectious Wound Complications after Mastectomy on Subsequent Surgical Procedures and Early Implant Loss.
abstract: Noninfectious wound complications (NIWCs) after mastectomy are not routinely tracked and data are generally limited to single-center studies. Our objective was to determine the rates of NIWCs among women undergoing mastectomy and assess the impact of immediate reconstruction (IR).
  
  
  
  We established a retrospective cohort using commercial claims data of women aged 18 to 64 years with procedure codes for mastectomy from January 2004 through December 2011. Noninfectious wound complications within 180 days after operation were identified by ICD-9-CM diagnosis codes and rates were compared among mastectomy with and without autologous flap and/or implant IR.
  
  
  
  There were 18,696 procedures (10,836 [58%] with IR) among 18,085 women identified. The overall NIWC rate was 9.2% (1,714 of 18,696); 56% required surgical treatment. The NIWC rates were 5.8% (455 of 7,860) after mastectomy only, 10.3% (843 of 8,217) after mastectomy plus implant, 17.4% (337 of 1,942) after mastectomy plus flap, and 11.7% (79 of 677) after mastectomy plus flap and implant (p < 0.001). Rates of individual NIWCs varied by specific complication and procedure type, ranging from 0.5% for fat necrosis after mastectomy only, to 7.2% for dehiscence after mastectomy plus flap. The percentage of NIWCs resulting in surgical wound care varied from 50% (210 of 416) for mastectomy plus flap, to 60% (507 of 843) for mastectomy plus implant. Early implant removal within 60 days occurred after 6.2% of mastectomy plus implant; 66% of the early implant removals were due to NIWCs and/or surgical site infection.
  
  
  
  The rate of NIWC was approximately 2-fold higher after mastectomy with IR than after mastectomy only. Noninfectious wound complications were associated with additional surgical treatment, particularly in women with implant reconstruction, and with early implant loss.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Katelin B
authors.initials: KB
authors.lastname: Nickel
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Ida K
authors.initials: IK
authors.lastname: Fox
authors.affiliation: Division of General Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Margenthaler
authors.affiliation: HealthCore, Inc., Wilmington, DE.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Wallace
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO. Electronic address: molsen@dom.wustl.edu.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
mesh_terms: D019928:Breast Implantation / Q000009:adverse effects*; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005218:Fat Necrosis / Q000209:etiology / Q000601:surgery; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D011475:Prosthesis Failure; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects / Q000473:pathology; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery