Technical aspects of immediate breast reconstruction--two year follow-up of 100 patients treated consecutively

We report the technical aspects of immediate breast reconstruction of the first 100 consecutive patients done at the Karolinska Hospital. Two patients had bilateral cancer. Preoperative chemotherapy had been given to five patients and postoperative chemotherapy to 13 patients. In 96 patients the indication was breast carcinoma. Mean tumour size was 13.1 mm and always less than 100.0 mm. Radiotherapy had been given preoperatively in nine patients and postoperatively in 10 patients. Mean operation time was 127 minutes, and median operating time 100 minutes. Hospital stay was five days. Breast reconstructions were performed with permanent prostheses in 22, expanders in 66, pedicled TRAM flaps in eight, and free TRAM flaps in four patients. To complete the breast reconstruction one major and 1.4 minor operations were needed. Total time to reconstruction was 461 days. The overall complication rate was 16%, with 13 local complications. Three developed haematomas, seven lost their implants, two developed partial necroses of pedicled TRAM flaps, and one developed abdominal bulging after a free TRAM flap. Patients were followed up after 2.0-5.7 years. The capsular contracture rate in the implant group was 24%.