IMMEDIATE BREAST RECONSTRUCTION IN BREAST-CANCER - MORBIDITY AND OUTCOME

Breast reconstruction is frequently pe;formed for and requested by wom en with breast cancer. There are continued concerns about the safety o f this procedure. We reviewed the Medical College of Georgia experienc e with immediate breast reconstruction to determine overall morbidity and whether premorbid risk factors could predict complications. Patien ts were reviewed with attention to epidemiologic characteristics, como rbid medical conditions, and risk factors; hospital and operative cour se; immediate wound complications; and patient survival, t test and ch i-square analysis were performed to determine risk factors for develop ing wound complications. Between October 1990 and December 1996, 55 pa tients underwent 62 mastectomies and immediate reconstruction for brea st cancer or contralateral prophylaxis. There were 13 stage 0, 23 stag e I,16 stage II, 4 stage III, and I stage IV tumors. There were 19 pro sthetic and 43 autologous tissue reconstructions. Eighteen patients ha d 24 wound complications. Major complications occurred in eight patien ts and required reoperation for implant removal (two bilateral), ventr al herniorrhaphy, and split thickness skin grafting for tissue loss. P atients who were obese were statistically more likely to develop surgi cal wound complications. Tobacco use, age, comorbid medical illness, o perative blood loss, length of operation, and length of hospital stay did not predict for the development of wound complications. Patients w ho underwent prosthetic reconstruction had a significantly higher rate of major wound complications when compared with those who had autolog ous reconstruction. There was a single ease of delay of chemotherapy s econdary to surgical wound complication. There were no cases of autolo gous flap loss or local recurrence. Median survival is 23 months (1-72 months). At last follow-up, 53 patients are alive and without evidenc e of local recurrence. Breast reconstruction may be performed safely f or most breast cancer patients. Autologous tissue reconstruction is pr eferred and carries significantly less major morbidity. Reconstruction should not delay adjuvant chemotherapy.