Plastic Surgery Research Council
Members Only  |  Contact  |  PSRC on Facebook
PSRC 60th Annual Meeting

Back to Annual Meeting Program


Timing And Technical Implications Of Breast Reconstruction In Anemic Women: The Advantages Of Staged (Delayed-Immediate) Breast Reconstruction
Pablo A. Baltodano, MD1, José M. Flores, MPH2, Nicholas B. Abt, BS1, Karim A. Sarhane, MD, MSc1, Francis M. Abreu, BS2, Karen K. Burce, MHS1, Carisa M. Cooney, MPH1, Damon S. Cooney, MD, PhD1, Justin M. Sacks, MD1, Gedge D. Rosson, MD1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Purpose: Anemia, a common finding in breast cancer patients, is independently associated with adverse outcomes after breast reconstruction. If treating anemia before surgery is not possible due to urgency of breast cancer treatment, anemic women undergoing mastectomy should be offered the reconstruction strategy associated with the lowest morbidity. In the present study, we sought to determine the safest reconstructive approach to anemic women undergoing mastectomy.
METHODS: We analyzed women undergoing mastectomy with or without reconstruction from 2005-2011 using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases. All anemic females (hematocrit <36%, WHO definition) were identified and multivariable logistic regression was used to compare 30-day postoperative morbidity between patients undergoing mastectomy-only vs. immediate breast reconstruction. Subgroup analysis compared morbidity within the immediate breast reconstruction groups: tissue expanders (TE), implants, and flaps. Morbidity events included: wound, prosthesis/flap failure, cardiac, respiratory, neurological, urinary, and venous thromboembolism complications.
RESULTS: 77,902 women underwent mastectomy with or without immediate reconstruction: 11,770 (15.1%) anemic, 52,943 (68.0%) non-anemic women, while 13,189 (16.9%) had missing hematocrit data (Figure 1). Among anemic women, mastectomy-only had lower morbidity (11.13%) than immediate breast reconstruction (13.25%, p=0.015) (Table 1). Subgroup analysis of anemic women undergoing immediate reconstruction revealed that TE had significantly lower morbidity (9.83%) than both, implant (13.10%, p=0.019) or flap reconstructions (24.63%, p=0.001) (Table 2).
CONCLUSION: For anemic women undergoing immediate reconstruction, staged (delayed-immediate) reconstruction (using TE) carries lower morbidity than implant or flap-based reconstructions. Future studies should investigate the effect of treating preoperative anemia on reconstruction morbidity profiles



Back to Annual Meeting Program