Identifying Patient Risk Factors in Prepectoral Breast Reconstruction
Michael Holland, Rachel Lentz, M.D., Clara Gomez-Sanchez, M.D., Hani Sbitany, M.D..
University of California, San Francisco, San Francisco, CA, USA.
Immediate 2-stage prepectoral breast reconstruction aims to provide a better approach than traditional submuscular reconstruction. Although previously shown to be a safe alternative to submuscular reconstruction, limited studies have characterized the patient specific and perioperative factors contributing towards unwanted outcomes.
A retrospective review was performed of all patients undergoing immediate prepectoral breast reconstruction by the senior author (H.S.) between 2015-2018. Patient characteristics, operative details, and postoperative outcomes were analyzed to identify factors contributing towards successful results.
One-hundred thirty-two patients underwent a total of 221 prepectoral breast reconstructions with a mean follow up of 11 months. Patients with BMI greater than 25, age greater than 60, hypertension, hyperlipidemia, ASA class, and active smoking all had higher odds of any complication including return to OR (overall 17.2%), readmission (overall 8.6%), tissue expander loss (overall 10.4%). A history of premastectomy radiation was associated with increased healing complications (OR 7.77; p = 0.009) Neoadjuvant chemotherapy was not associated with increased complications, although adjuvant chemotherapy was associated with higher tissue expander loss (OR 3.14; p = 0.024). Prophylactic postoperative antibiotics were associated with significantly decreased wound and infectious complications (P < 0.05). Preservation of the nipple was not associated with worse outcomes.
Prepectoral breast reconstruction can yield successful outcomes in patients previously considered high risk. The identification of high-risk patients preoperatively can aid in intraoperative decision making and preoperative patient counseling. Prophylactic antibiotics should decrease complication rates.
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