Comparison of 2-year-complication rates Among Common Techniques for Postmastectomy Breast Reconstruction

Katelyn G. Bennett, MD, Ji Qi, MS, Hyungjin M. Kim, ScD, Jennifer B. Hamill, MPH, Andrea L. Pusic, MD, and Edwin G. Wilkins, MD, MS

Published: JAMA Surgery, October 2018

 

Question asked:

How do long-term complications compare across procedure types in postmastectomy breast reconstruction?

Study population:

Mastectomy Reconstructions outcomes Consortium Study was a multicenter prospective cohort funded by the national cancer institute to compare the long-term of common techniques of breast reconstruction. The patients included all women 18 years and older presenting for first-time breast reconstruction after mastectomy for cancer treatment at 1 of 11 institutions across the United States. Patients were recruited from February 1, 2012- July 31, 2015.

The study included women undergoing direct to implant (DTI/EI) procedures, latissimus dorsi (LD) flap, pedicled transverse rectus abdominis myocutaneous (pTRAM) flap, free transverse rectus abdominis myocutaneous (fTRAM) flap, DIEP flap, or superficial inferior epigastric artery (SIEA) flap procedures

Study Design:

Two-year post reconstruction complication rates were compared across procedure type.

There were a total of 2343 patients, with average age of 49.5

The ratio of procedures in the study were as following: 112 DTI technique (4.8%), 1525 EI (expander implant) technique (65.1%), 85 pTRAM flap (3.6%), 95 fTRAM flap (4.1%), 390 DIEP flap (16.6%), 71 LD flap (3.0%), and 65 SIEA flap reconstructions (2.8%). A total of 2184 reconstructions (93.2%) were performed at the time of mastectomy, and 1266 (54.0%) were bilateral. A total of 2095 patients (89.4%) underwent mastectomies for cancer treatment, and 1093 patients (46.6%) underwent sentinel lymph node biopsy.

Primary outcomes:

• All complications, reoperative complications and wound infections.
• Complication was defined as an adverse, postoperative, surgery-related event that required additional treatment.

Results:

771 (32.9%) experienced a complication. A total of 453 patients (19.3%) had a reoperative complication, and 126 reconstructions (5.4%) failed. The overall complication rate was highest among patients with SIEA flaps (48 [73.9%]), whereas reoperative complications occurred more frequently in non-LD flap autologous reconstructions compared with implant-based techniques. By contrast, patients undergoing DTI or EI procedures had the highest failure rates (DTI failure rate, 8 [7.1%]; EI failure rate, 108 [7.1%]).

Compared to the EI procedures, all the flap procedures carried a higher risk for complications, including reoperative complications.

There was a higher risk of reoperative complications for older women, higher BMI. Higher BMI was also associated with higher risk of infection.

Patients undergoing delayed reconstruction were at lower risk for complications compared to those undergoing immediate reconstruction. Smokers and patients undergoing radiotherapy and chemotherapy were also at higher risk for reoperative complications and infection.

Race, ethnicity, income, marital status, educational level and employment status did not affect rate of complications.