Making an informed choice: Which breast reconstruction type has the lowest complication rate?

Area of Science:

• Oncology
• Plastic Surgery
• Reconstructive Surgery

Background:

• Breast reconstruction is a critical component of post-mastectomy care.
• Understanding long-term outcomes and complication rates is essential for patient counseling.
• Implant-based breast reconstruction (IBBR) and autologous tissue reconstruction (ATR) are common methods.

Purpose of the Study:

• To investigate and report long-term breast reconstruction outcomes.
• To provide data-driven counseling information for patients considering breast reconstruction.
• To compare complication rates between different breast reconstruction techniques.

Main Methods:

• Retrospective review of 399 patients undergoing mastectomy with reconstruction from 2010-2017.
• Reconstruction types included 1-stage IBBR, 2-stage IBBR, and ATR.
• Major complications were defined as any unplanned return to the operating room (OR).

Main Results:

• Overall complication rates were similar across 1-stage IBBR (59%), 2-stage IBBR (60%), and ATR (52%).
• Diabetes (OR=25.4) and 1-stage IBBR versus ATR (OR=2.0) were independently associated with major complications.
• Bilateral procedures showed increased risk of major complications on univariate analysis (OR=1.59).

Conclusions:

• Long-term breast reconstruction complication rates exceed previous expectations.
• IBBR is associated with higher rates of complications, including unplanned OR returns, compared to ATR.
• Patient counseling should reflect these findings for informed decision-making.