Complications analysis of 266 immediate breast reconstructions.

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

Complications analysis of 266 immediate breast reconstructions.

* Pinsolle V,
* Grinfeder C,
* Mathoulin-Pelissier S,
* Faucher A.

Service de Chirurgie Plastique CHU Bordeaux/Universite Bordeaux 2,
Hopital Pellegrin Tondu, Place Amelie Raba-Leon, 33076 Bordeaux Cedex,
France. vincent.pinsolle@chu-bordeaux.fr

The purpose of this study was to describe the complications of
immediate breast reconstruction, to compare their rates with respect
to the surgical procedure and to patient's characteristics, in order
to improve surgical indications and patient information. We carried
out a retrospective study of 266 immediate breast reconstructions (249
women) over a 12-year period (latissimus dorsi myocutaneous flap with
implant 61%, autologous latissimus dorsi myocutaneous flap 15%,
subpectoral implant 24%). Mean age was 48 and the median follow-up was
seven years (2-14). The overall complication rate was 49% (128), and
there were 10 reconstruction failures. The most frequent complications
were dorsal seroma 26% (70), capsular contracture 10% (27), skin
necrosis 8.3% (22), and haematoma 5.6% (15). The complication rate for
immediate breast reconstruction with implant alone (39%) was lower
than that associated with latissimus dorsi with or without implant
(51%), but the difference was not significant (Chi-square: p=0.07).
The risk factors for complications were smoking (skin necrosis,
Fisher: p=0.02), obesity (infection, Fisher: p=0.004), and
radiotherapy (capsular contracture, Chi-square: p=2.6 x 10(-5)).
Smoking was found as the only risk factor of reconstruction failure
(Fisher: p=0.015). Capsular contractures were more frequent when
implants were used alone (25%) as well as when used along with a flap
(6.8%) (Chi-square: p=2 x 10(-5)). Infections were also higher in the
non-flap group than in the flap group (Fisher: p=0.02). In our
opinion, latissimus dorsi myocutaneous flap with or without an implant
is a good compromise between complication risk and necessity of good
cosmetic result requirement. These results have led us to delay or
contraindicate reconstruction in the case of obesity or heavy smoking.
In the case of probable post-operative radiotherapy, we prefer to
delay the breast reconstruction.

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