Immediate breast reconstruction in breast cancer: morbidity and outcome

Breast reconstruction is frequently performed for and requested by women with breast cancer. There are continued concerns about the safety of this procedure. We reviewed the Medical College of Georgia experience with immediate breast reconstruction to determine overall morbidity and whether premorbid risk factors could predict complications. Patients were reviewed with attention to epidemiologic characteristics, comorbid medical conditions, and risk factors; hospital and operative course; immediate wound complications; and patient survival. t test and chi-square analysis were performed to determine risk factors for developing wound complications. Between October 1990 and December 1996, 55 patients underwent 62 mastectomies and immediate reconstruction for breast cancer or contralateral prophylaxis. There were 13 stage 0, 23 stage I, 16 stage II, 4 stage III, and 1 stage IV tumors. There were 19 prosthetic and 43 autologous tissue reconstructions. Eighteen patients had 24 wound complications. Major complications occurred in eight patients and required reoperation for implant removal (two bilateral), ventral herniorrhaphy, and split thickness skin grafting for tissue loss. Patients who were obese were statistically more likely to develop surgical wound complications. Tobacco use, age, comorbid medical illness, operative blood loss, length of operation, and length of hospital stay did not predict for the development of wound complications. Patients who underwent prosthetic reconstruction had a significantly higher rate of major wound complications when compared with those who had autologous reconstruction. There was a single case of delay of chemotherapy secondary to surgical wound complication. There were no cases of autologous flap loss or local recurrence. Median survival is 23 months (1-72 months). At last follow-up, 53 patients are alive and without evidence of local recurrence. Breast reconstruction may be performed safely for most breast cancer patients. Autologous tissue reconstruction is preferred and carries significantly less major morbidity. Reconstruction should not delay adjuvant chemotherapy.