An outcome study of breast reconstruction: Presurgical identification of risk factors for complications

Background: Breast reconstruction following mastectomy has been shown to ha ve a salutary effect on the overall psychological well-being of women being treated for breast cancer. Unfortunately, however, not every patient is an ideal candidate for reconstruction. Complications stemming from reconstruc tive surgery can cause significant morbidity, the most important of which m ay be the delay of subsequent adjuvant antineoplastic therapies, and theref ore may not be in the best interests of the patient. Methods: A retrospective study was performed on a consecutive series of 123 breast reconstructions in 98 patients, performed by one of two plastic sur geons, in a university setting over a 5-year period, for all surgical outco mes. Specifically, wound-healing complications, infections, and reoperation s leading to the potential delay of subsequent chemotherapy or radiotherapy were recorded, and possible risk factors leading to these were sought. Results: Three presurgical risk factors were found to have a statistically significant influence on the development of complications following breast reconstruction. These were: (1) increasing obesity, defined by the body mas s index, (2) an active or recent (<5 year) history of cigarette smoking, an d (3) a history of previous radiation exposure. Odds ratios were used to de scribe the magnitude of the effect of each factor for the development of co mplications. An ordinal regression analysis was used to create a nomogram b ased on this information that can be used to calculate any individual patie nt's presurgical risk for developing major complications following breast r econstruction, based on the presence of these factors. Conclusions: It is possible, based on the presence of specific presurgical risk factors, to predict the probability of developing major complications following breast reconstruction. This information can be useful to the refe rring physician and plastic surgeon alike in determining which patients are the best candidates for breast reconstruction and which type of reconstruc tion would be best suited for each individual patient.