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Identification of complications in mastectomy with immediate reconstruction using tissue expanders and permanent implants for breast cancer patients

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Abstract

Background

Since complications of postmastectomy breast reconstruction may reduce patient satisfaction, we investigated complications of reconstruction with tissue expanders (TEs), particularly surgical site infections requiring TE/permanent implant (PI) removal.

Patients and methods

A retrospective review was performed of 234 primary breast cancer patients undergoing 239 postmastectomy breast reconstructions with TEs/PIs from 1997 to 2009. Clinicopathological findings and postoperative complications, particularly infections, were analyzed. Data were analyzed by the Chi-square test and a multivariate logistic regression model. TE infection risk factors considered for model inclusion were excisional biopsy, (neo) adjuvant chemotherapy, lymph node resection, body mass index (BMI), simultaneous bilateral reconstructions, and seroma aspiration.

Results

Removal of TEs/PIs was observed in 15.5 % (37/239) of reconstructions, and 18/37 underwent re-reconstructions. Of the 19/37 reconstructions that were not achieved completely, the most frequent reason was TE infection (11 reconstructions). The completion rate was 92 % (220/239 reconstructions) and it was significantly higher in reconstructions without TE infection than with infection (96 vs. 54 %, p < 0.0001). Patients with BMI ≥ 25 kg/m2 and seroma aspiration were more likely to develop TE infections (p = 0.0019, p < 0.001, respectively). By multivariate logistic regression analysis, seroma aspiration was a significant independent risk factor for TE infection (odds ratio 28.75, 95 % confidence interval 5.71–40.03, p < 0.0001).

Conclusion

To improve completion rates of breast reconstruction, prevention of TE infection plays a key role. We should reduce unnecessary seroma aspirations and delay elevation/exercise of the ipsilateral arm.

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Conflict of interest

All the authors have read the manuscript and approved this submission. No financial support for this study was provided. The authors report no conflicts of interest.

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Authors and Affiliations

  1. Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan

    Daisuke Ota, Atsushi Fukuuchi, Takao Kato, Masashi Takeuchi & Tsunehiro Nishi

  2. Breast Surgery Clinic, 2-21-43 Takanawa, Minato-ku, Tokyo, 108-0074, Japan

    Yoshiko Iwahira

  3. Department of Surgery, Nippon Kokan Hospital, 1-2-1 Kokandori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0852, Japan

    Joji Okamoto

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  1. Daisuke Ota
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  2. Atsushi Fukuuchi
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  3. Yoshiko Iwahira
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  4. Takao Kato
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  5. Masashi Takeuchi
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Correspondence to Daisuke Ota.

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Ota, D., Fukuuchi, A., Iwahira, Y. et al. Identification of complications in mastectomy with immediate reconstruction using tissue expanders and permanent implants for breast cancer patients. Breast Cancer 23, 400–406 (2016). https://doi.org/10.1007/s12282-014-0577-4

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  • DOI: https://doi.org/10.1007/s12282-014-0577-4

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