Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Immediate versus Delayed Reconstruction After Mastectomy -- An Analysis of 30 Day Post-Operative Outcomes
Paymon Sanati-Mehrizy, BA, Benjamin B. Massenburg, BA, John M. Rozehnal, BA, Michael J. Ingargiola, MD, Jonatan Hernandez-Rosa, MD, Peter J. Taub, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.

PURPOSE:
Optimal timing of breast reconstruction after mastectomy remains a question for the reconstructive plastic surgeon. The objective of this study was to evaluate the frequency of various post-operative complications in patients undergoing either immediate or delayed breast reconstruction after mastectomy for malignancy.
METHODS:
The ACS-NSQIP 2005-2012 database was queried via CPT and ICD-9 codes for patients who underwent mastectomy for the treatment of breast malignancy. These mastectomy cases were then stratified based on concomitant procedures to identify whether immediate reconstruction was performed, generating a “mastectomy alone” and a “mastectomy with immediate reconstruction” cohorts. The database was additionally queried for isolated reconstructive breast procedures with ICD-9 codes indicating a history of malignant breast neoplasm, identifying a cohort of “delayed-reconstruction” patients. All reconstruction patients were then stratified based upon reconstructive modality, including tissue expander/implant (TE/I) reconstruction and flap-based reconstruction. The frequency of post-operative complications, including return to the OR, wound and medical complications, surgical site infections, post-operative transfusions, and device or flap failure was assessed. A multiplicative risk model was used to calculate the probability of post-operative complications after undergoing a mastectomy alone followed by reconstruction on a different date. These values were compared to the frequency of post-operative complications in the “mastectomy with immediate reconstruction” cohort, and one-sample binomial tests were performed to determine statistical significance.
RESULTS:
A total of 49,450 cases that underwent either mastectomy alone (n=30226), mastectomy with immediately TE/I reconstruction (n=13513), mastectomy with immediate flap reconstruction (n=2854), delayed TE/I reconstruction (n=2047), or delayed flap reconstruction (n=810) were identified. When compared to a calculated probability of post-operative complications for undergoing a mastectomy alone and subsequent delayed TE/I reconstruction, mastectomy with immediate reconstruction using TE/I was associated with decreased return to OR (p=0.03), decreased wound complications (p<0.001), decreased medical complications (p<0.001), decreased superficial surgical site infections (p<0.001), and decreased post-operative transfusions (p<0.001). However, immediate reconstruction using TE/I was associated with increased organ-space surgical site infections (p<0.02) and increased device failure (p<0.001) (Table 1).
When compared to a calculated probability of post-operative complications for undergoing a mastectomy alone and subsequent flap-based reconstruction, mastectomy with immediate flap reconstruction was associated with decreased return to OR (p<0.001), decreased wound complications (p<0.001), decreased medical complications (p<0.001), and decreased superficial SSI (p<0.001). However, immediate reconstruction was associated with increased flap failure (p<0.001). (Table 2).


CONCLUSION:
Immediate reconstruction after mastectomy using TE/I or flap-based reconstruction was associated with decreased post-operative complications, including wound and medical complications, superficial SSI, and need for return to the OR. However, immediate reconstruction with either modality was associated with increased device or flap failure, and immediate TE/I reconstruction was associated with increased organ-space SSI. Understanding these nuances allows for improved risk counseling and decision-making for patients and their surgeons.


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