Breast reconstruction: systemic factors influencing local complications

One hundred seven consecutive breast reconstructions in 83 women were retrospectively reviewed. The reconstructions were with subpectoral prostheses, 54 with permanent tissue expanders, 14 with temporary tissue expanders, and 39 with permanent implants. Immediate breast reconstruction was performed in 69 (64%) breasts and delayed breast reconstruction in 38 (36%) breasts. Risk factors for local complication were diabetes, smoking, age older than 60 years, obesity, and hypertension. Technical factors reviewed included timing of reconstruction, type of prosthesis used, and the presence or absence of drains. Women with immediate breast reconstruction sustained a significantly higher complication rate than women with delayed breast reconstruction; however, the majority of these were due to the antecedent mastectomy. Complications due to the reconstruction were not significantly different for women with immediate versus delayed breast reconstruction. Implant loss occurred in 5 women, 4 with immediate and 1 with delayed breast reconstruction (5.8% vs. 2.6%, p approximately 0.47). Diabetes was significant, and smoking and age greater than 60 years approached significance as risk factors for implant loss in women with immediate breast reconstruction (p approximately 0.01, 0.05, and 0.08, respectively). These risk factors also correlated directly with an increasing severity of complication in women with immediate breast reconstruction (r = 0.414, p = 0.06). Technical factors showed no significant effect on implant loss in women with immediate breast reconstruction.