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. 2020 Jul;182(2):345-354.
doi: 10.1007/s10549-020-05705-3. Epub 2020 May 28.

Predictive risk factors of complications in different breast reconstruction methods

J S Palve  1 , T H Luukkaala  2 , M T Kääriäinen  3
Affiliations

Predictive risk factors of complications in different breast reconstruction methods

J S Palve et al. Breast Cancer Res Treat. 2020 Jul.

Abstract

Purpose: Women with different BMI, age and comorbidities seek for breast reconstruction. It is critical to understand the risk associated with each technique to ensure the most appropriate method and timing is used. Outcome after reconstructions have been studied, but consensus is lacking regarding predictive risk factors of complications. The authors present their experience of different autologous and alloplastic reconstructions with an emphasis on predictors of complications.

Methods: Prospectively maintained reconstruction database from 2008 to 2019 was reviewed. Factors associated with complications were identified using logistic regression, multinomial logistic regression and risk factor score to determine predictors of complications.

Results: A total of 850 breast reconstructions were performed in 793 women, including 447 DIEP, 283 LD, 12 TMG and 51 implant reconstructions. Complications included minor (n = 231, 29%), re-surgery requiring (n = 142, 18%) and medical complications (n = 7, 1%). Multivariable analysis showed that complications were associated independently with BMI > 30 (OR 1.59; 95% CI 1.05-2.39, p = 0.027), LD technique (OR 4.05; 95% CI 2.10-7.81, p < 0.001), asthma or chronic obstructive pulmonary disease (OR 2.77; 95% CI 1.50-5.12, p = 0.001) and immediate operation (OR 0.69; 95% CI 0.44-1.07, p = 0.099). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the risk score increased (35%, 61%, 76% and 100% for 1, 2, 3 and 4 risk scores, respectively, p < 0.001).

Conclusions: The rate of complication can be predicted by a risk-scoring system. In increasing trend of patients with medical problems undergoing breast reconstruction, tailoring of preventive measures to patients' risk factors and careful consideration of the best timing of reconstruction is mandatory to prevent complications and costs.

Keywords: Breast reconstruction; Complication; DIEP; Implant reconstruction; LD; Risk factor.

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Conflict of interest statement

The authors state that they have no conflicts of interest.

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