What Is in a Number? Evaluating a Risk Assessment Tool in Immediate Breast Reconstruction

Ischemic complications after immediate breast reconstruction have devastating consequences; however, individual risk assessment remains challenging. We seek to develop an intraoperative assessment tool to assist in estimating risk of ischemic complications in immediate breast reconstruction.

Patients undergoing immediate breast reconstruction were prospectively identified and evaluated with an intraoperative mastectomy flap ischemia risk assessment tool consisting of 8 binary questions. Breast measurements and patient demographics were recorded. Reconstructions were then prospectively evaluated postoperatively for ischemic complications. Outcomes were analyzed with significance set at P values <0.05.

Thirty-one patients underwent 45 immediate breast reconstruction. The majority of reconstructions were tissue expander based (64.4%) following therapeutic (62.2%) skin-sparing (93.3%) mastectomies. Average follow-up was 11.16 months. Sixteen reconstructions (35.6%) experienced an ischemic complication. The average total mastectomy flap ischemic risk score was 4.29. The correlation value of higher scores with increasing ischemic complications was 0.65. Reconstructions with scores greater than 5 had significantly higher rates of ischemic complications (P = 0.0025). Reconstructions with a score of >6 and >7 also had significantly higher rates of ischemic complications (P < 0.0001, each). The sensitivity and specificity of intraoperative mastectomy flap compromise were 81.25% and 62.07%.

Ischemic complications after immediate breast reconstruction were positively correlated with higher scores using a clinical intraoperative mastectomy flap ischemia risk assessment tool. Scores greater than 5 seem to be a threshold value at which ischemic complications are significantly greater. This simple, easy-to-implement intraoperative tool may assist plastic surgeons in assessing risk and optimizing outcomes in immediate breast reconstruction.