Impact of Diabetes on 30-Day Complications in Mastectomy and Implant-Based Breast Reconstruction

Rifkin, William J.; Kantar, Rami S.; Cammarata, Michael J.; Wilson, Stelios C.; Diaz-Siso, J. Rodrigo; Golas, Alyssa R.; Levine, Jamie P.; Ceradini, Daniel J.

doi:10.1016/j.jss.2018.09.063

Cited by 26 publications

(23 citation statements)

References 61 publications

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“…Our study revealed that diabetic patients had a nine-fold increased likelihood of developing early-onset lymphedema as compared to those who were not. It was reported that breast cancer patients with diabetes undergoing mastectomy or extensive tissue dissection are challenged with delayed wound healing due to disruption of the local blood supply and tissue hypoxia [55]. Therefore, we hypothesized that the occurrence of BCRL in diabetic patients was increased due to the delayed wound healing caused by breast surgery and the increased arm morbidity associated with these individuals.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

et al. 2021

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Breast cancer has been reported to have the highest survival rate among various cancers. However, breast cancer survivors face several challenges following breast cancer treatment including breast cancer-related lymphedema (BCRL), sexual dysfunction, and psychological distress. This study aimed to investigate the potential risk factors of BCRL in long term breast cancer survivors. A total of 160 female breast cancer subjects were recruited on a voluntary basis and arm lymphedema was assessed through self-reporting of diagnosis, arm circumference measurement, and ultrasound examination. A total of 33/160 or 20.5% of the women developed BCRL with significantly higher scores for upper extremity disability (37.14 ± 18.90 vs. 20.08 ± 15.29, p < 0.001) and a lower score for quality of life (103.91 ± 21.80 vs. 115.49 ± 16.80, p = 0.009) as compared to non-lymphedema cases. Univariate analysis revealed that multiple surgeries (OR = 5.70, 95% CI: 1.21–26.8, p < 0.001), axillary lymph nodes excision (>10) (OR = 2.83, 95% CI: 0.94–8.11, p = 0.047), being overweight (≥25 kg/m2) (OR = 2.57, 95% CI: 1.04 – 6.38, p = 0.036), received fewer post-surgery rehabilitation treatment (OR = 2.37, 95% CI: 1.05–5.39, p = 0.036) and hypertension (OR = 2.38, 95% CI: 1.01–5.62, p = 0.043) were associated with an increased risk of BCRL. Meanwhile, multivariate analysis showed that multiple surgeries remained significant and elevated the likelihood of BCRL (OR = 5.83, 95% CI: 1.14–29.78, p = 0.034). Arm swelling was more prominent in the forearm area demonstrated by the highest difference of arm circumference measurement when compared to the upper arm (2.07 ± 2.48 vs. 1.34 ± 1.91 cm, p < 0.001). The total of skinfold thickness of the affected forearm was also significantly higher than the unaffected arms (p < 0.05) as evidenced by the ultrasound examination. The continuous search for risk factors in specific populations may facilitate the development of a standardized method to reduce the occurrence of BCRL and provide better management for breast cancer patients.

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Section: Discussionmentioning

confidence: 99%

Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

et al. 2021

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“…4,[15][16][17] Prior studies have identified multiple risk factors for post-mastectomy complications, including obesity, smoking, and diabetes. 18,19 Frailty is a more recently introduced concept 20,21 that is quantified using several measuring tools. [22][23][24][25][26][27] The mFI-5, an index of frailty, has been shown to validly predict outcomes in a wide variety of surgeries.…”

Section: Re Sultsmentioning

confidence: 99%

“…They were more likely to be older, smokers, and have higher BMI. Because these comorbidities are known to be risk factors in post-mastectomy patients, 18,19 control for confounding was performed using multivariate regression.…”

Section: Ta B L E 1 Descriptive Statistics Of Preoperative Variablesmentioning

confidence: 99%

Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5‐factor frailty index

et al. 2021

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Breast cancer remains the most commonly diagnosed cancer in women in the United States. 1 Surgical options include breast conservation surgery or mastectomy, with similar survival rates. 2,3 Patients who undergo mastectomy can subsequently decide to pursue immediate or delayed breast reconstruction. Postoperative complications of these procedures remain a major concern and lead to significant morbidity, including surgical site infection, skin flap necrosis, loss of implant, and need for reoperation. Complications can result in prolonged hospital stays, increased costs, and the delay of adjuvant therapy. 4 It is important to identify risk factors for post-mastectomy complications to provide adequate counseling and mitigate risk.Several predictors of surgical outcomes have been analyzed, including body mass index (BMI), smoking status, age, and medical comorbidities. More recently, the concept of frailty was introduced as a surrogate for physiologic age, with the goal of developing a more accurate predictor. Frailty is defined as a generalized, aging-related clinical state in which there is a diminished physiological reserve and function and an increased vulnerability to stressors, including surgery. 5 Frailty has been shown to be strongly associated with adverse outcomes, including postoperative complications, mortality,

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“…Based on analyses of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2010-2015, diabetic patients undergoing partial, total, or subcutaneous mastectomy were at greater risk of early post-operative surgical site infection-both superficial (partial and total mastectomy) and deep (total and subcutaneous) tissue infections (225). For diabetic women undergoing breast reconstruction, NSQIP data showed increased superficial surgical site infection with delayed but not immediate implant based procedures (225) and increased deep incisional infection, wound dehiscence, and post-operative length of stay with free flap reconstruction (226). In a retrospective study of diabetes and impact on complications in breast cancer patients undergoing mastectomy with immediate reconstruction, women with diabetes had significantly increased incidence of delayed wound healing with implant-based reconstruction but not autologous procedures (227).…”

Section: Pre-surgical Assessmentmentioning

confidence: 99%

Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin

Yee¹,

Mortimer²,

Natarajan³

et al. 2020

Front. Endocrinol.

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The potential association between obesity and TNBC has been a subject of intense research study. As outlined below, studies investigating the potential relationship between obesity and TNBC have been inconsistent. This is a summary of some of the key studies that have been recently published.The Carolina Breast Cancer Study is a North Carolina population-based case-controlled study of breast cancer, conducted in three phases (28). The current study phase, Phase 3 (years 2008-2014), includes women resident in 44 North Carolina Counties (28), employing randomized recruitment to oversample African-American/Black women and women under age 50 (28). Waist to hip ratio (WHR) was compared between the highest (≥0.84) and lowest (<0.77) groups vs. the basal-type subset of TNBC. There was an increased risk [odds ratio (OR) = 2.3; 95% CI, 1.4-3.6] for basal-type TNBC in women with higher WHR (43). Premenopausal women (OR = 1.8; 95% CI, 1.0-3.4) and post-menopausal women (OR = 2.7; 95% CI, 1.3-5.4) with the highest WHR had increased risk of developing basal-type TNBC compared to the lowest WHR (43). Basal-type breast cancer was observed to be highest among premenopausal African-American/Black women (43). There was no significant association between increased BMI (defined as BMI ≥ 25 kg/m 2 ) and basal-type TNBC.The Appalachian Study investigated the potential association between obesity (defined as BMI ≥ 30 kg/m 2 ) and TNBC in 620 predominantly non-Hispanic White women in rural Appalachia. This study reported a significant association between obesity and the incidence of TNBC (29).Women's CARE study is a case-controlled study of BMI and breast cancer risk in non-Hispanic White women and African-American/Black women. The Women's CARE study reported (1) an inverse association between a woman's BMI at age 18 and premenopausal ER-/PR-breast cancer and (2) a positive association between current BMI and post-menopausal ER+/PR+ breast cancer (30).

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Impact of Diabetes on 30-Day Complications in Mastectomy and Implant-Based Breast Reconstruction

Cited by 26 publications

References 61 publications

Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5‐factor frailty index

Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin

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