Journal of Plastic, Reconstructive & Aesthetic Surgery
Mastectomy with or without immediate implant reconstruction has similar 30-day perioperative outcomes
Introduction
Breast reconstruction following mastectomy provides patients with a psychosocial and aesthetic benefit,1, 2, 3, 4 yet postoperative morbidity can impact and alter recovery,4 satisfaction,1 and reconstructive cost.5 With rising national rates of bilateral mastectomy,6 immediate reconstruction, and the sustained popularity and use of implants,7 there is a significant need for generalizable outcomes data that quantify the relative risk of immediate tissue expander (TE) placement following mastectomy. Several studies to date have quantified the relative risk of reconstructive modality8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and defined predictors for device loss.19, 20 To date, there does not exist a direct comparison of matched patients who would be equally likely to select or undergo mastectomy alone or immediate breast reconstruction (IBR) using TE.
The importance of understanding population-level outcomes data as it relates to TE reconstruction lies in the opportunity to provide patients and surgeons with generalizable information to guide and enhance preoperative risk discussions, to assist in reconstructive modality selection, and to improve the understanding of risk in this commonly performed reconstructive procedure. The aim of this study was to compare the rates of 30-day perioperative complications following IBR using TE to mastectomy alone.
Section snippets
Database and analytic cohort
The 2005–2011 ACS-NSQIP databases were accessed on December 1, 2012 and queried to identify all female patients undergoing mastectomy alone or mastectomy with IBR using TE.21 Per NSQIP protocol, approximately 240 HIPPA compliant variables were collected for each encounter. These variables include patient demographic data and preoperative comorbid conditions, as well as procedure-related and outcomes data, including 30-day postoperative morbidity. Audits conducted through 2010 have shown an
Results
A total of 42,823 patients who underwent either mastectomy alone (N = 30,440) or mastectomy with concurrent TE placement (N = 12,383) were identified in the 2005–2011 ACS-NSQIP datasets. The majority of patients were Caucasian (71.2%) and 45–64 years of age (50.2%). Bivariate analysis revealed higher TE reconstruction rates during years 2009–2011 (P < 0.001), in Caucasian patients (P < 0.001), and in younger (P < 0.001) (Table 1). TE reconstruction patients had significantly lower ASA physical
Discussion
Immediate reconstruction has been shown to be associated with modality-specific risk14, 18 yet implant reconstruction has been demonstrated as an efficacious and reliable technique.26, 27 Evolving patterns of mastectomy use, including the rise in rates of prophylactic mastectomy and immediate implant-based breast reconstruction highlight the need to determine and characterize the relative risk of immediate TE reconstruction compared to mastectomy alone.6, 7
In this study, our principle aim was
Conclusion
Undergoing IBR with TE placement does not confer added risk of wound, medical, or overall morbidity relative to mastectomy alone based upon propensity-matched 30-day complication rates in 15,238 patients from the 2005–2011 ACS-NSQIP datasets.
Financial support
This particular research received no internal or external grant funding.
Conflicts of interest
The authors report no relevant financial disclosures related to this current work.
Ethical approval
De-identified patient information is freely available to all institutional members who comply with the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Data Use Agreement. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996.
Disclosure
None of the authors listed have any relevant conflicts of interest to report.
Disclaimer
The ACS-NSQIP and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors of this study.
IRB
IRB and HIC exemption were obtained by our institutions.
Author role/participation
JPF – conception, data analysis, drafting, critical revisions.
AMW – data analysis, critical revisions.
CTT – data acquisition and management, critical revisions.
JAN – critical revisions.
JCT – conception, critical revisions.
SJK – conception, drafting, critical revisions.
JMS – critical revisions.
LCW – conception, critical revisions.
Acknowledgments
We would like to acknowledge and thank Nancy Folsom, BSN for her assistance in the organization and preparation of the IRB for this study.
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2016, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Immediate reconstruction was also a protective factor from the occurrence of seroma, with a 68% reduction in the risk of this complication (OR = 0.32, CI 95%, 0.12–0.90). Similar results were shown in an American study comparing women subjected to mastectomy with and without immediate reconstruction with implants, where no increase was found in the morbidity rates from the surgical wound in the first 30 days after surgery.36 Another study performed in a single institution showed no increase in general and neuropathic pain after immediate reconstruction when compared with patients subjected to mastectomy alone.37