The Effects of Hemoglobin A1c on Complications in Implant-Based Breast Reconstruction

Abstract

Background Given the prevalence of diabetes and high complication rate of breast reconstruction, it is prudent to ascertain if there is an association between hemoglobin A1C levels and outcomes in patients undergoing implant-based breast reconstruction. This may help guide clinical decision making and also inform patients of their relative risk of complications. Methods A retrospective review of 203 patients that underwent implant-based breast reconstruction at a single institution was conducted. All patients required a documented pre-operative A1C. Patients were then categorized by A1C level into three groups: normal (<5.7%), prediabetic (5.7% to 6.4%), or diabetic (>6.5%). Patient demographics and postoperative complications were evaluated in relation to A1C values during both the initial tissue expander placement and subsequent exchange operations. Data was evaluated using a two-sample t-test for continuous variables, chi-squared for categorical variables and univariate logistic regression models were performed. Results 203 patients were divided into normal (n=135), pre-diabetic (n=40), and diabetic (n=28) cohorts. Patients in the diabetic and pre-diabetic group were generally older (p=0.011), Caucasian (p=0.007), higher weight (p=0.002) with elevated BMI (p<0.001), and a higher percentage of hypertension (p<0.001). The prediabetic and diabetic groups had a higher percentage of overall complication rate (57.5% and 53.8% respectively), when compared to the normal cohort (31.3%) (p=0.003). The percentage of patients that sustained a loss of their tissue expanders was also increased in the prediabetic (10%) and diabetic groups (22.2%) (p= 0.029). The diabetic population was more likely to have a complication (OR=2.56, 95% CI [1.09,6.00]) and to have tissue expander loss (OR 4.5, 95% CI [1.42,14 .28]) after their tissue expander placement when compared to the normal population. There was no increased complications or tissue expander loss associated with A1C levels for the subsequent surgery for permanent implant placement. Conclusion Patients with elevated A1C are at an increased risk for overall complications and diabetic patients are at increased risk for tissue expander loss during the first stage of implant-based breast reconstruction. There were no associated risks for the implant exchange procedure. A preoperative hemoglobin A1C should be considered for patients seeking implant-based tissue expander breast reconstruction to discuss surgical risk.