title: Complications in Postmastectomy Breast Reconstruction: One-year Outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study.
abstract: OBJECTIVE
  In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. This study sought to evaluate complications in a large, multicenter patient population.
  
  
  BACKGROUND
  Previous studies have reported widely varying complication rates, but have been limited by their single center designs and inadequate controlling for confounders in their analyses.
  
  
  METHODS
  Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction following mastectomy for cancer treatment or prophylaxis. Procedures included expander/implant, latissimus dorsi (LD), pedicle transverse rectus abdominis musculocutaneous (PTRAM), free TRAM (FTRAM), and deep inferior epigastric perforator (DIEP) techniques. Data were gathered pre- and postoperatively from medical records. Separate logistic regressions were conducted for all complications and major complications (those requiring rehospitalization and/or reoperation) within 1 year. Odds ratios (ORs) were calculated for procedure type, controlling for site, demographic, and clinical variables.
  
  
  RESULTS
  Complication rates for 2234 patients were analyzed. Compared with expander/implant reconstructions, LD (OR) 1.95, P = 0.026), PTRAM (OR 1.89, P = 0.025), FTRAM (OR 1.94, P = 0.011), and DIEP (OR 2.22, P < 0.001) procedures were associated with higher risks of complications. Significantly higher risks were also associated with older age, higher body mass index (BMI), immediate reconstruction, bilateral procedures, and radiation. For major complications, regression showed significantly greater risks for PTRAM (OR 1.86, P = 0.044) and DIEP (OR 1.75, P = 0.004), than expander/implant reconstructions. Failure rates were relatively low, ranging from 0% for PTRAM to 5.9% for expander/implant reconstructions.
  
  
  CONCLUSIONS
  In this multicenter analysis, procedure choice and other patient variables were significant predictors of 1-year complications in breast reconstruction. These findings should be considered in counseling patients on reconstructive options.
authors.affiliation: Section of Plastic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
authors.affiliation: Section of Plastic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hamill
authors.affiliation: Center for Statistical Consultation and Research, University of Michigan, University of Michigan, Ann Arbor, MI.
authors.forename: Hyungjin M
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL.
authors.forename: John Y
authors.initials: JY
authors.lastname: Kim
authors.affiliation: The Georgia Institute for Plastic Surgery, Savannah, GA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Greco
authors.affiliation: Section of Plastic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Ji
authors.initials: J
authors.lastname: Qi
authors.affiliation: Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
mesh_terms: D029681:Arabidopsis Proteins; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy; D008875:Middle Aged; D009687:Nuclear Proteins; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D029681:Arabidopsis Proteins; D009687:Nuclear Proteins; C523534:TIC protein, Arabidopsis