by Chouairi,
Fouad; Gabrick, Kyle S.; Avraham, Tomer; Markov, Nickolay P.; Alperovich,
Michael
Background: Two-stage implant breast reconstruction is the most commonly performed
breast reconstruction procedure. Limited data exist regarding reconstruction
complication rates examined by mastectomy indication.
Methods: Patients who underwent two-stage implant breast reconstruction at Yale
New Haven Hospital from 2011 to 2017 were included in the study. Perioperative
complications were compared. Chi-square analysis, t tests, and Fisher’s exact
tests were used to determine significant associations. A binary logistic
regression was used to determine variables with a significant impact on the
likelihood of mastectomy flap necrosis.
Results: Between 2011 and 2017, complete perioperative records were available
for 141 patients who underwent 226 mastectomies followed by two-stage tissue
expander/permanent implant reconstruction. Of the 226 mastectomies, 134 were
therapeutic and 92 were prophylactic. On regression analysis, there were no
significant differences in demographics, comorbidities, or mastectomy and
reconstructive details between the two breast groups except for there being
more modified radical mastectomies in therapeutic breasts (p = 0.003). When
comparing complications, there was a significantly higher risk of mastectomy
flap necrosis in the therapeutic group (p = 0.017). Therapeutic mastectomies
had a 9.5 times higher risk of mastectomy flap necrosis than prophylactic
mastectomies when adjusted for confounding variables. There were no significant
differences in other reconstructive complications between the two groups.
Conclusions: Patients undergoing therapeutic mastectomies
have a significantly higher risk of mastectomy flap necrosis than those
undergoing prophylactic mastectomies. Although the underlying cause still needs
to be determined, differences in technique may be related to mastectomy flap
necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
