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

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.

Keywords: Breast cancer; breast reconstruction; deep inferior epigastric perforator (DIEP) flap; implant reconstructions; latissimus dorsi (LD) flap; postoperative complications.

Figure 1

The diagram illustrates the relationship between the independent risk factors of smoking and BMI, and their probability for early overall complications. The combination resulted in a considerably increased risk compared to the presence of only one risk factor. DIEP, deep inferior epigastric perforator; BMI, body mass index.

Figure 2

The diagram illustrates the relationship between the independent risk factors of smoking and history of radiotherapy and their probability for early local complications. The combination resulted in a considerably increased risk compared to the presence of only one risk factor. DIEP, deep inferior epigastric perforator.

Figure 3

The diagram illustrates the relationship between the independent risk factors of increased BMI, smoking, and radiotherapy, and their risk for early administration of antibiotics when they are combined. All curves, irrespective of method, show a positive association between increased risk factor and risk for complication. As BMI increases, and is combined with smoking and history of radiotherapy, the risk curves are shifted upwards. The combination resulted in a considerably increased risk compared to the presence of only one risk factor. BMI, body mass index.

Figure 4

The diagram illustrates the relationship between the independent risk factor of increased BMI, combined with radiotherapy on the risk for late overall complications. The combination resulted in a considerably increased risk compared to the presence of only one risk factor. DIEP, deep inferior epigastric perforator; BMI, body mass index.

Figure 5

The diagram illustrates the relationship between the independent risk factor of smoking combined with rheumatic disease on the risk for late resurgery. The combination resulted in a considerably increased risk compared to the presence of only one risk factor. DIEP, deep inferior epigastric perforator.

Figure 6

The diagram illustrates the relationship between the independent risk factor of increased BMI combined with history of radiotherapy on late fat necrosis. As BMI increases, the risk curves are shifted upwards. The combination results in a considerably risk compared to the presence of only one risk factor. BMI, body mass index.