THE RAMIFICATIONS OF IMMEDIATE RECONSTRUCTION IN THE MANAGEMENT OF BREAST-CANCER

A retrospective review of 50 patients who underwent immediate postmast ectomy breast reconstruction was performed to determine the effect of reconstruction on the treatment of these patients. The overall complic ation rate was 50% (25 of 50). Smoking statistically correlated with a n increased rate of wound complications (0 = 0.0001). Obese patients h ad nearly twice as many wound complications; however, this finding was not statistically significant (P = 0.261). Eleven of the 50 patients underwent reconstruction with a prosthesis, with an overall complicati on rate of 64% (seven of 11) and a 55% (six of II) rate of prosthesis loss. Thirty-nine of the 50 patients underwent reconstruction with aut ologous tissue. Forty-six per cent (18 of 39) of the patients in the a utologous group developed complications, and eight required emergent r eoperation to prevent flap loss. The wound complication rate was signi ficantly lower for bipedicled transverse rectus abdominis muscle (TRAM ) flap reconstructions than for other forms of autologous reconstructi on (P = 0.040). Total operative time (including mastectomy) was 3.11 h ours (range, 2-4 hours) for the prosthetic group and 9.4 hours (range, 5-15 hours) for the autologous group. All but two patients undergoing autologous tissue reconstruction required blood transfusions; an aver age of 2.4 U of blood was transfused per patient (range, 0-7 U). Only two patients in the prosthetic group required a transfusion. The avera ge hospital stay was 5 days (range, 2-7 days) for the prosthetic group and 8.3 days (range, 5-19 days) for the autologous tissue group. Both groups required an average of one additional procedure to complete th e desired cosmetic result (prosthetic group: range, 0-3; autologous gr oup: range, 0-6). Smoking and obesity are associated with an increased complication rate and should be considered in selection criteria. Alt hough immediate reconstruction offers significant psychosocial benefit s to patients undergoing mastectomy, the complication rates and the ne ed for transfusion, prolonged hospital stays, and additional procedure s must be considered when reconstruction is planned.