9 Comparison of Immediate Breast Reconstruction Outcomes in Patients With and Without Prior Breast Cosmetic Surgical Procedures
Caroline Fiser, MD1; Sophia Liu, MD1; Neha Goel, MD2; Joshua Kronenfeld, MD1; Wrood Kassira, MD3; John Oeltjen, MD3; Susan Kesmodel, MD2
1DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine, Miami,FL
2DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology, University of Miami School of Medicine, Miami, FL
3DeWitt Daughtry Family Department of Surgery, Division of Plastics and Reconstructive Surgery, University of Miami School of Medicine, Miami, FL
Background
The use of skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) has increased considerably. There is limited information on the complications of IBR in patients with prior breast cosmetic surgical procedures. We compare IBR outcomes in patients undergoing SSM/NSM with and without prior breast cosmetic surgery.
Methods
Patients undergoing mastectomy from January 1, 2017 to December 31, 2019 were selected. Patient characteristics, surgical approach, and complication rates were compared between mastectomy and IBR cases on breasts with and without prior cosmetic surgical procedures. Binary logistic regression analysis was performed to identify factors associated with complications and reconstruction loss.
Results
A total of 956 mastectomies were performed in 697 patients, with IBR performed for 546 mastectomies in 352 patients. There were 189 patients who had bilateral mastectomy, 158 had unilateral mastectomy, and 5 had 2 unilateral mastectomies at different times (10 total mastectomies). The median age was 51 years (range, 19-83 years); 45.7% of patients were younger than 50 years; 28.9% received neoadjuvant systemic therapy; and 62.6% of mastectomies were performed for breast cancer. There were 95 mastectomies (17.4%) performed on breasts with prior cosmetic surgical procedures and 451 (82.6%) without. The NSM procedures were more commonly performed for breasts with prior cosmetic surgery (P < .001). Complications occurred after 75 mastectomies (13.7%) and reconstruction loss in 31 (5.7%). On multivariable analysis, NSM (HR, 2.16; 95% CI, 1.19-3.94) was associated with an increased risk of any complication, while NSM (HR, 2.70; 95% CI, 1.13-6.43) and direct to implant reconstruction (HR, 2.62; 95% CI, 1.14-6.02) were associated with reconstruction loss. Prior breast cosmetic surgical procedures were not associated with an increased risk of complications (HR, 1.05; 95% CI, 0.53-2.06) or reconstruction loss (HR, 1.24; 95% CI, 0.48-3.17).
Conclusion
In this analysis of mastectomy and IBR, prior breast cosmetic surgical procedures were not associated with an increased risk of complications or reconstruction loss. In patients with prior breast cosmetic surgical procedures undergoing mastectomy, IBR may be safely performed.
