Breast Trauma: A Decade of Surgical Interventions And Outcomes From us Trauma Centers

Abstract

Background Traumatic breast injuries that require surgical intervention are rare and incompletely studied. The study objective was to define the incidence, mechanism/burden of injury, interventions, and outcomes after breast injuries requiring surgery nationally. Methods All patients with breast trauma necessitating surgery were identified from the National Trauma Data Bank (NTDB) (2006-2017) using ICD-9 and -10 codes, without exclusions. Demographics, injury mechanism/severity, procedures, and outcomes (mortality, hospital length of stay [LOS, days], ICU LOS, and AIS >1 in >1 body regions, defining multisystem trauma) were compared with ANOVA or Chi-squared tests, as appropriate. Results In total, 899 patients (.01% of NTDB) met study criteria. Median age was 41 years and most patients were female (n = 802, 89%). Penetrating trauma was the most common injury mechanism (n = 395, 44%), followed by blunt trauma (n = 369, 41%) and burns (n = 135, 15%). Median ISS was higher after blunt trauma than penetrating trauma or burns (10 vs 5 vs 4, P < .001). Laceration repair/mastotomy was the most common procedure among penetrating (n = 354, 90%) and blunt (n = 265, 72%) trauma patients, while mastectomy was the most common after burns (n = 126, 93%). Breast procedures varied significantly by mechanism (P < .001). Conclusion Breast injuries requiring surgery are uncommon. Most occur following penetrating trauma, although injury severity is highest after blunt trauma and mortality is highest after burns. Procedure type, injury severity, and outcomes varied significantly by mechanism of injury, implying that breast trauma should be considered within the context of injury mechanism. These findings may assist with prognostication after breast trauma necessitating surgical intervention.

Breast Trauma: A United States-Based Epidemiological Study From 2016 to 2019

“…This data reveals that trauma patients with a traumatic breast abrasion or contusion have, on average, a higher likelihood of having additional comorbidities. This is consistent with the findings of Sargent et al in which ISS were highest after blunt breast trauma compared to penetrating [ 10 ]. Sanders et al reported in a retrospective analysis of female blunt breast trauma patients that the most common associated comorbidities included long bone fractures (45%) and rib fractures (44%) [ 8 ].…”

“…These sample characteristics are similar to previous epidemiologic and self-reporting studies [ 6 - 8 ]. Although not specified in this study, the majority of traumatic breast injuries occur from MVAs [ 5 - 8 , 10 - 13 ].…”

“…Despite this, angiographic intervention in patients with arterial extravasation of the breast remains controversial [ 15 , 16 ]. Patients with complex breast injuries that were hemodynamically unstable went to the operating room for laceration repair, mastotomy, or in some cases, mastectomy [ 10 ].…”

Traumatic Breast Injuries in High-Risk Communities

“…Burns were shown to have a higher mortality rate and length of hospital stay compared to blunt or penetrating trauma. 2 Despite the morbidity of these injuries, the existing literature is lacking.…”

“…Similarly, a large nationwide study analyzing breast trauma demographics recognized that younger patients were linked to more penetrating breast injuries. 2 Patients with traumatic breast injuries may be linked to domestic violence trauma, especially penetrating breast injuries. In our study, 27% of penetrating breast injuries were documented due to domestic or partner violence.…”