Plastic Surgery Research Council
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IMPACT OF CONNECTIVE TISSUE DISEASE ON OUTCOMES FOLLOWING BREAST SURGERY AND RECONSTRUCTION
Presenter: Kenneth L Fan, MD
Co-Authors: Patel KM; Franklin B; Albino FP; Nahabedian MY
UCLA

Background: Various patient factors influence the ability to perform breast surgery safely. Studies have shown that overall complication rates range from 5-20% in breast surgery and reconstruction. The impact of connective tissue disease (CTD) on the healing and eventual outcome following breast surgery and/or reconstruction has not been well described.

Methods: A retrospective review was conducted of all patients who underwent breast surgery from 2005-2010. Patients were identified as having breast surgery and having an active diagnosis of a connective tissue disease. Logistic regression was utilized to examine the relationship between peri-operative complications and type of surgery, CTD diagnosis, and immunosuppression. The a priori p-value was set at p < 0.05 and all tests were two-sided.

Results: Among 33 patients isolated, diagnoses included: psoriasis/psoriatic arthritis (n=12), rheumatoid arthritis (n=10), lupus (n=4), scleroderma (n=3), sjogrens (n=2), mixed connective tissue disease (n =1), and seronegative polyarthritis (n=1). 112 procedures occurred among this cohort of patients. 4 groups were isolated: ablative surgery alone (MS), autologous reconstruction (AR), implant reconstruction (IR), and revision (RS) cohorts (Table 1). Patients with psoriatic arthritis had significantly increased chances of developing a minor complication as compared to other CTDs, while significantly lower rates occurred among MS cohort. 58% patients were controlled with systemic treatment for CTD in the peri-operative period. Although patients on plaquenil had a significantly increased minor complication rate (OR=2.72; p=0.007), patients on systemic therapy in the peri-operative period had significantly decreased likelihood of minor complications (OR=0.69; p=0.007), but did not affect major complication rates.

Conclusion: Breast reconstruction among patients with connective tissue diseases can be performed safely with low complication rates. Systemic therapy in the peri-operative period seems to decrease minor complication rates in most cohorts, and major complication rates are unaffected by CTD systemic therapy.


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