Major complication rate after mastectomy with implant reconstruction in a community hospital setting
Owens WL. Major complication rate after mastectomy with implant reconstruction in a community hospital setting. J Patient-Centered Res Rev. 2014;1:55.
Presented at 2013 Aurora Scientific Day, Milwaukee, WI
Background/significance: Mastectomy with implant reconstruction is offered to most patients with early stage breast cancer, and is sought by many desiring risk reduction mastectomy. An increased risk of major complication in mastectomy with reconstruction over mastectomy alone or lumpectomy with radiation is acknowledged, but is dependent on the breast center: technique and experience of breast and plastic surgeons, choice of implant over autologous reconstruction, and radiation oncologist opinion regarding postmastectomy radiation.
Purpose: Calculate the incidence of major complication after mastectomy with implant reconstruction at Aurora BayCare Medical Center (ABMC). Determine the rate at which postmastectomy radiation is performed at ABMC. Examine the influence of post-mastectomy radiation on the major complication rate. Compare ABMC complication rates with published results from major medical centers. Consider ways to reduce the major complication rate at ABMC.
Methods: Retrospective record review from 8/2009-1/2013 of all mastectomies with immediate implant reconstruction performed at ABMC. Major complication defined as implant loss, with or without attempts at further reconstruction.
Results: 137 implant reconstructions were performed at ABMC in 86 patients with a median follow-up of 21.3 months. Reconstruction was performed after cancer surgery in 77 cases, and after risk reduction surgery in 60 cases. Mastectomy was skin sparing in 74 cases, and nipple sparing in 63 cases. When reconstruction was done after cancer surgery, 31.2% had radiation. After reconstruction, overall 16% had major complication. Rate was 5% after risk reduction surgery, and 24.7% after cancer surgery. Of those cancer patients who received post-mastectomy radiation, 41.7% had major complication; of those who did not receive radiation, complication rate was 17%. ABMC major complication rates compared favorably with those published from major centers, but post-mastectomy radiation rate was higher at ABMC.
Conclusion: Though comparable to major centers, implant loss after mastectomy with immediate reconstruction is not uncommon at ABMC, and especially when the mastectomy is performed for cancer, and remarkably high if post-mastectomy radiation is performed. ABMC clinicians can consider methods to reduce the major complication rate while following NCCN management guidelines: improved surgical margins after mastectomy, higher threshold for recommending radiation after mastectomy, and use of autologous reconstruction after radiation.