Plastic Surgery Research Council

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The Impact of Ptosis, Breast Size, and Surgical History on Complications in Autologous Breast Reconstruction
Jeffrey N. Li, BS, BBA, Avinash P. Jayaraman, BA, Connie Ma, BA, Catherine E. Sobieski, MS, Austin A. Hembd, MD, Sumeet S. Teotia, MD, Nicholas T. Haddock, MD.
UT Southwestern Medical Center, Dallas, TX, USA.

Introduction: Previous studies have attempted to elucidate risk factors in autologous breast reconstruction associated with wound complications and outcome with varying results. BMI is a risk factor clearly associated with a variety of reconstructive complications. Pre-operative breast size has also been independently associated with infection and skin flap necrosis in expander-implant based reconstruction. However, there are few examinations of pre-operative breast dimensions and other comorbidities as a prognostic indicator of complications in free flap-based autologous reconstruction.
Methods: Retrospective chart review was performed on free-flap autologous breast reconstructions performed by two senior surgeons at UTSW (NTH, SST). Patients were divided into 2 groups:
1. No Complications (n=755) or No Serious Complications (non-operative or outpatient treatment)
2. Serious Complications (n=111) (requiring OR treatment or IV antibiotics)
t-tests, χ2 tests, and box fisher tests were run for continuous, binary, and <5 samples variables using R. Logistic multi-variate regression was performed to control for BMI.
Results: Even after controlling for BMI: age, smaller cup size, patients with grade 0 ptosis, and narrower breasts (base diameter, cm) were significantly different between groups (p=0.01, 0.04, 0.02, 0.02, respectively). Patients with prior surgical history of breast implant or tissue expander, breast reconstruction, or lumpectomy were also significantly more likely to have serious complications (p=0.05, 0.02, <0.001, respectively). Smoking status, DM, HTN, hypercoagulability, autoimmunity, and history of abdominal, oncologic, or cosmetic surgery were not significantly different.
Conclusions: This study provides clinical evidence that larger breast size is correlated with increasing serious complications, independent of BMI, in free-flap autologous breast reconstruction after breast cancer. These complications required an extra return to OR or readmission, a clinically significant decision. Extra precautions should be taken in patients of advanced age, larger cup size, greater ptosis, and wider breasts to minimize risk of serious complications. Patients with previous breast surgical history should also be counseled of their greater risk for serious complications.
1. Moran SL, Serletti JM. Outcome comparison between free and pedicled TRAM flap breast reconstruction in the obese patient. Plast Reconstr Surg. 2001;108:1954Y1960

Comparison of Characteristics Between Serious Complications and No Serious Complications Patients
CharacteristicPatients with No Serious Complication (n=755)Patients with Serious Complication (n=111)P ValueP Value Adjusting for BMI
Age, mean (SD)52.6 (9.7)55 (8.2).01*.01*
Cup Size B (%)72 (17)14 (28).09.04*
Cup Size E (%)51 (12)6 (12)1.97
Ptosis Grade 0 (%)90 (18.9)3 (5.1).01*.02*
Breast Base Diameter, cm, mean (SD)15.4 (2.8)16.3 (2.8).01*.02*
Previous Breast Implant or Tissue Expander95 (13.7)23 (20.9).07.05*
HistoryBreast Reconstruction100 (14.6)24 (23.3).03*.02*
HistoryLumpectomy101 (14.5)31 (28.2).001*<.001*
HistoryCosmetic Breast Surgery55 (7.9)13 (11.9).22.26


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