Abstract: Implant Reconstruction Does Not Require Any More Procedures than Autologous Reconstruction for Completion

Abstract

INTRODUCTION: Breast reconstruction may require multiple procedures beyond the initial surgery. Estimates range from 2 1,2 to 6 3 procedures required. The reconstructive course may stretch over months and even years.4 Previous studies of the number of procedures and amount of time required to complete breast reconstruction have been limited in the factors considered and have reached conflicting conclusions. The authors aimed to determine the number of procedures and length of time it took a large, diverse, population of women to complete breast reconstruction. METHODS: Women undergoing breast reconstruction since 2003 with follow up in our institution’s medical record system were reviewed. Reconstruction completion was defined by the last procedure a patient underwent, even if she did not undergo nipple/areolar reconstruction. Chisquared and independent t-tests were used to identify variables associated with number of procedures and length of time required for reconstruction. Significantly associated (p<0.05) variables were used in regression analysis. RESULTS: Four hundred thirty three patients were included. Seventy-five patients with procedures pending at the end of follow-up were excluded. Patients underwent an average of 4.06 ± 1.95 procedures (range 2–12) over 593 ± 648 days. Marital status, ethnicity, occupational status, axillary dissection, radiation, chemotherapy, laterality, and reconstruction type were not associated with either number of procedures or length of time required. In a linear regression predicting time required for reconstruction, higher BMI was associated with shorter time requiredfor reconstruction (16.5 days per unit BMI increase, p=0.006) and undergoing nipple reconstruction or tattooing was associated with increased time (287 days extra, p<0.0001). In a linear regression predicting number of procedures required for reconstruction, undergoing nipple or areola reconstruction (p<0.0001), dehiscence (p=0.033), seroma (p=0.030), implant exposure (p=0.001), hematoma (p<0.0001), partial flap loss (p<0.0001), implant infection (p<0.0001), and number of complications (p<0.0001) positively predicted increased number of operations. Nipple reconstruction or tattooing and partial flap loss were the strongest predictors, with 1.92 and 2.67 additional procedures associated with each respectively. CONCLUSIONS: The patients in this study underwent a number of procedures falling between previous estimates. As expected, complications and nipple reconstruction/tattooing were associated with increased numbers of procedures. Eom et al. found that expander-implant reconstruction patients underwent more procedures than autologous reconstructions while Losken et al. found the reverse – in the present cohort, no difference between reconstruction types was found.2,3 Similarly, radiation exposure and chemotherapy were not associated with increased number of procedures as reported elsewhere.2 The current findings reinforce that breast reconstruction may be a prolonged and arduous process. REFERENCES: 1 Damen TH, Mureau MA, Timman R, Rakhorst HA, Hofer SO. The pleasing end result after DIEP flap breast reconstruction: A review of additional procedures. J Plast Reconstr Aesthet Surg. 2009;62:71–76. doi:10.1016/j.bjps.2007.09.045. 2 Eom JS, Kobayashi MR, Paydar K, Wirth GA, Evans GRD. The number of operations required for completing breast reconstruction. Plast Reconstr Surg Glob Open. 2014;2:e424. doi: 10.1097/GOX.0000000000000111 3 Losken A, Carlson GW, Schoemann MB, Jones GE, Culbertson JH, Hester TR. Factors that influence the completion of breast reconstruction. Ann Plast Surg. 2004;52:258–262. doi:10.1097/01.sap.0000110560.03010.7c 4 Losken A, Duggal CS, Desai KA, McCullough MC, Gruszynski MA, Carlson GW. Time to completion of nipple reconstruction: What factors are involved? Ann Plast Surg. 2013;70:530–532. doi:10.1097/SAP.0b013e318281ac61