title: Breast reconstruction after mastectomy: A ten-year analysis of trends and immediate postoperative outcomes.
abstract: The landscape of breast reconstruction has changed significantly. This study assesses trends in type of reconstruction performed after mastectomy and impact on immediate postoperative complications.
  
  
  METHODS
  Data for 67,450 patients undergoing mastectomy for breast cancer were analyzed using the National Surgical Quality Improvement Program (NSQIP) database for years 2005-2014. Primary outcomes were wound, nonwound related infections, and bleeding complications. Data were analyzed by univariate and multivariate analysis.
  
  
  RESULTS
  The percentage of patients that underwent reconstruction after breast cancer increased from 26.94% in 2005 to 43.30% in 2014 (p < 0.01). There was increased wound (5.59%), bleeding (6.82%), and infection (1.80%) complications after flap-based reconstruction (p < 0.01). There was no difference in wound, infection, and bleeding complications between immediate implant reconstruction and tissue expander (TE) at 4.38 vs. 3.89% (p = 0.18), 0.82 vs. 0.7%, p = 0.46), and 0.76 vs. 0.64% (p = 0.45), respectively. Several independent factors were associated with increased wound complications in patients undergoing all or any forms of reconstruction after mastectomy such as being overweight (OR 1.38, CI 1.23-1.55), obese (OR 2.11, CI 1.89-2.35), morbidly obese (OR 3.84, CI 3.34-4.43), ASA Class III (OR 1.35, CI 1.08-1.69), ASA Class IV (OR 1.49, 1.06-2.10), diabetic (OR 1.28 , CI 1.14-1.43), and smokers (OR 1.76, CI 1.59-1.94). TRAM flap was associated with increased risk of wound complication (OR 1.87, CI 1.28-2.75).
  
  
  CONCLUSIONS
  More women are undergoing reconstruction as utilization of TE increases drastically. Immediate implant placement has only seen moderate increase likely due to surgeon preference.
authors.affiliation: Department of Surgery, Mount SinaiSt. Luke's, Mount Sinai West Hospitals, New York, NY, United States. Electronic address: nilonzo@chpnet.org.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ilonzo
authors.affiliation: Department of Surgery, Mount SinaiSt. Luke's, Mount Sinai West Hospitals, New York, NY, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Tsang
authors.affiliation: Department of Surgery, Mount SinaiSt. Luke's, Mount Sinai West Hospitals, New York, NY, United States.
authors.forename: Sara
authors.initials: S
authors.lastname: Tsantes
authors.affiliation: Department of Surgery, Mount SinaiSt. Luke's, Mount Sinai West Hospitals, New York, NY, United States.
authors.forename: Alison
authors.initials: A
authors.lastname: Estabrook
authors.affiliation: Department of Surgery, Mount SinaiSt. Luke's, Mount Sinai West Hospitals, New York, NY, United States.
authors.forename: Aye Moe
authors.initials: AM
authors.lastname: Thu Ma
mesh_terms: D000368:Aged; D018427:Breast Implants / Q000009:adverse effects / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D008408:Mastectomy; D008875:Middle Aged; D050177:Overweight / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects / Q000706:statistics & numerical data; D013997:Time Factors; D015625:Tissue Expansion Devices / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Breast reconstruction; Mastectomy; Trends