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Breast Reconstructive Outcomes After Hematomas: A Study Of Over 600 Tissue Expander Breast Reconstructions
Hunter Rogoff, BS1, Jocellie Marquez, MD, MBA1, Kanad Ghosh, BA1, Kaitlin Monroig, BA1, Christopher Medrano, BA1, William Marmor, BS1, Austin Ferrier, BS1, Phoebe McAuliffe, BA1, Kailash Kapadia, MD1, Sourish Rathi, BE2, Tara Huston, MD, FACS3, Jason Ganz, MD3, Sami Khan, MD, FACS3, Alexander Dagum, MD3, Duc Bui, MD3.
1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 2Stony Brook University, Stony Brook, NY, USA, 3Division of Plastic and Reconstructive Surgery at Stony Brook University Hospital, Stony Brook, NY, USA.

PURPOSE:
Hematomas following tissue expander immediate breast reconstruction (TE-IBR) pose a significant challenge during the recovery period. In this study, we aim to evaluate the consequences of hematoma formation on outcomes and how management can impact final reconstructive goals.
METHODS:
A single-institution retrospective review of TE-IBRs from 2001 to 2018 was performed utilizing an established breast reconstruction database. Demographics, medications, comorbidities and complications were identified. Implant loss was defined as removal of the expander/implant without immediate replacement. Hematoma size, management, transfusion requirement, reoperations, and final outcomes were recorded. Reconstructive failure was defined as implant loss that was never replaced and/or required secondary autologous reconstruction. Delayed TE-IBRs, autologous reconstructions and any hematomas occurring after another complication were excluded.
RESULTS:
627 TE-IBRs were analyzed. Post-operative hematoma (Group 1) occurred in 4% (n=26) of TE-IBRs and did not develop in 96% (Group 2: n=601). Group 2 had a higher mean BMI (24.5 vs. 27.3, p=0.018); however, there were no significant differences in smoking status, pre-/post-operative radiation/chemotherapy, or other comorbidities. Group 1 was found to have increased rates of implant loss (15.4% vs. 3.7%, p=0.0033) and reconstructive failure (11.5% vs 2.8%, p=0.0133) compared to Group 2. There were no differences for any other complications.
69.2% (n=18) of hematomas underwent surgical intervention (Group 1a) compared to 30.8% (n=8) that were clinically managed (Group 1b). Group 1a had statistically significant lower rates of subsequent complications (22.2% vs. 62.5%, p=0.046) and reoperations (5.5% vs. 27.5%, p=0.037) than Group 1b. Subsequent complications included infection, capsular contracture, wound dehiscence, seroma, and implant loss.
Lastly, 23.1% (n=6) of patients who developed a hematoma were on home antithrombotics (Group 1c) compared to 76.9% (n=20) no-antithrombotics (Group 1d). There were statistically significant differences in transfusion rates (50% vs. 0%, p=0.001) between Groups 1c and 1d, respectively. Differences in hematoma volume (330 mL vs. 169.33 mL, p=0.078) and reconstructive failure (33.3% vs. 5%, p=0.057) approached significance between both groups.
CONCLUSIONS:
Patients who develop a hematoma after TE-IBR should be monitored closely, as they are at significant risk for implant loss and reconstructive failure. In addition, patients on home antithrombotics are at increased risk for larger hematomas and failure of expander/implant salvage. Plastic surgeons should consider aggressive surgical evacuation of post-operative TE-IBR hematomas to reduce complications and reoperations thus optimizing reconstructive outcomes.


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