Reoperation cascade in postmastectomy breast reconstruction and its associated factors: Results from a long‐term population‐based study

Abstract

Background: Unplanned surgeries following postmastectomy breast reconstruction (PMBR) may be required to treat complications or to revise the reconstructed breast. The primary objective of this study was to examine factors that influenced unplanned reoperations after PMBR. Methods: A retrospective cohort study using provincial databases in Ontario, Canada, was completed. Patients with breast cancer underwent mastectomy between April 2002 and March 2012 followed by immediate or delayed PMBR. Primary outcome was time from PMBR to unplanned reoperations measured in years. The Anderson-Gill counting process model was used to estimate the risk of recurrent unplanned reoperations over time. Univariate and multivariate analyses were completed to examine the association between covariates. Results: A total of 3066 women underwent PMBR and 51.7% had at least one unplanned reoperation. Unplanned breast reoperation was significantly associated with microsurgical tissue vs implant-based reconstruction (hazard ratio [HR]: 1.27), radiation after PMBR (HR: 1.22), surgery at a nonteaching hospital (HR: 1.16), patient comorbidity score (HR: 1.02), and prior unplanned reoperations (HR: 1.25). Conclusions: Our study provides important long-term population-level data regarding factors influencing unplanned reoperations after PMBR. Patients undergoing microsurgical PMBR or postmastectomy radiation had a higher rate of additional procedures. Every additional reoperation also increases the likelihood of unplanned reoperations resulting in a "reoperation cascade."

Impact of procedure type on revisional surgery and secondary reconstruction after immediate breast reconstruction in a population-based cohort

“…Previous studies have generated conflicting results regarding the impact of procedure type on the need for revisional surgery 8 , but this is likely to reflect heterogeneity in the definitions of revision used and the duration of follow-up in the included studies. Two recently published large North American studies 24 , 25 have both suggested that revision rates are higher after autologous reconstruction. The first 25 included 1996 women from the Mastectomy Reconstruction Outcomes Consortium prospective cohort with 2 years’ postoperative follow-up.…”

“…The first 25 included 1996 women from the Mastectomy Reconstruction Outcomes Consortium prospective cohort with 2 years’ postoperative follow-up. Although complications after autologous reconstruction, such as fat necrosis or wound healing problems, occur in the early postoperative phase 24 , implant-related complications including malposition or capsular contracture are more likely to occur several years after surgery. Two years would not be sufficient to capture the impact of these issues, which may explain the results.…”

“…Two years would not be sufficient to capture the impact of these issues, which may explain the results. The second population-based study 24 from Canada reported the outcomes from 3066 women, 1714 of whom underwent IBR with up to 10 years’ follow-up. Women in this study underwent surgery as early as 2002 and the authors reported a 50 per cent unplanned surgery rate in the microsurgical group in the early study period.…”

Oral antibiotics do not prevent infection or implant loss after immediate prosthetic breast reconstruction: Evidence from 683 consecutive reconstructions without prophylaxis.

“…2,3 SSI results in a substantial health care burden arising from readmission, repeated surgery, and reconstructive failure, all of which can compromise quality-oflife outcomes. 4,5 The higher rates of infection after implant-based PMBR have been attributed to the presence of bacteria in the breast gland; mastectomy flap ischemia; and the placement of foreign bodies such as acellular dermal matrix (ADM), mesh, drains, and the implant or tissue expander itself.…”