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Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Journal article
Authors Andri Thorarinsson
Victoria Fröjd
Lars Kölby
Mattias Lidén
Anna Elander
Hans Mark
Published in Gland Surgery
Volume 6
Issue 4
Pages 355-367
ISSN 2227-684X
Publication year 2017
Published at Institute of Clinical Sciences, Department of Plastic Surgery
Pages 355-367
Language en
Links doi.org/10.21037/gs.2017.04.04
Keywords Breast cancer, breast reconstruction, deep inferior epigastric perforator (DIEP) flap, implant, epigastric perforator flap, skin-sparing mastectomy, postmastectomy, radiation-therapy, chest-wall radiotherapy, saline-filled implants, tram, flap, tissue expander, venous thromboembolism, multivariate-analysis, 12-year experience, Surgery
Subject categories Plastic surgery

Abstract

Background: Breast reconstruction is an essential component in the treatment of breast cancer. Postoperative complications after breast reconstruction are common and affect patient satisfaction. Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. Methods: We retrospectively enrolled 623 consecutive patients who underwent reconstruction with a deep inferior epigastric perforator flap (DIEP), latissimus dorsi flap (LD), lateral thoracodorsal flap (LTDF), or tissue expander with a secondary implant (EXP) in this study. Information on demographic and perioperative factors was collected, as well as information on all postoperative complications. Logistic regression was used to analyze associations between possible patient-related risk factors and postoperative complications. Results: Smoking was associated with the highest number of early overall complications [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially. Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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