Bennett KG, et al. - In a multicenter patient population, researchers evaluated 2-year complication rates across common techniques for postmastectomy reconstruction. It was noted that the overall complication rate was 32.9%. Compared with patients undergoing expander-implant techniques, patients undergoing all autologous reconstruction types had significantly higher odds of developing any complication. They found significant differences across reconstructive procedure types for overall and reoperative complications, which is critically significant information for women and doctors making breast reconstruction decisions.

Methods

• It was a longitudinal, multicenter, prospective cohort study.
• This investigation conducted from February 1, 2012, through July 31, 2015, took place at the 11 study sites associated with the Mastectomy Reconstruction Outcomes Consortium study.
• Women 18 years and older presenting for first-time breast reconstruction with at least 2 years of follow-up were eligible patients for inclusion.
• Methods assessed included direct-to-implant (DTI) technique, expander-implant (EI) technique, latissimus dorsi (LD) flap, pedicled transverse rectus abdominis myocutaneous (pTRAM) flap, free transverse rectus abdominis myocutaneous (fTRAM) flap, deep inferior epigastric perforator (DIEP) flap, and superficial inferior epigastric artery (SIEA) flap.
• Postmastectomy breast reconstruction was the main intervention.
• Main outcomes and measures analyzed were development of complications, reoperative complications, and wound infections during 2-year follow-up.
• Mixed-effects logistic regression analysis controlled for variability among centers and for demographic and clinical variables.

Results

• Inclusion criteria was met by 2343 patients (mean [SD] age, 49.5 [10.1] years; mean [SD] body mass index, 26.6 [5.7]).
• An aggregate of 1525 patients (65.1%) had EI reconstruction, with 112 (4.8%) receiving DTI reconstruction, 85 (3.6%) pTRAM flaps, 95 (4.1%) fTRAM flaps, 390 (16.6%) DIEP flaps, 71 (3.0%) LD flaps, and 65 (2.8%) SIEA flaps.
• They noted complications in 771 (32.9%), with reoperative complications in 453 (19.3%) and wound infections in 230 (9.8%).
• Two years postoperatively, compared with patients undergoing EI reconstruction (pTRAM flap: odds ratio [OR], 1.91; 95% CI, 1.10-3.31; P=.02; fTRAM flap: OR, 2.05; 95% CI, 1.24-3.40; P=.005; DIEP flap: OR, 1.97; 95% CI, 1.41-2.76; P < .001; LD flaps: OR, 1.87; 95% CI, 1.03-3.40; P=.04; SIEA flap: OR, 4.71; 95% CI, 2.32-9.54; P < .001), those undergoing any autologous reconstruction type had significantly higher odds of developing any complication.
• All flap procedures were associated with higher odds of reoperative complications (pTRAM flap: OR, 2.48; 95% CI, 1.33-4.64; P=.005; fTRAM flap: OR, 3.02; 95% CI, 1.73-5.29; P < .001; DIEP flap: OR, 2.76; 95% CI, 1.87-4.07; P < .001; SIEA flap: OR, 2.62; 95% CI, 1.24-5.53; P=.01) vs EI techniques with the exception of LD flap reconstructions.
• Only patients undergoing DIEP flaps had significantly lower odds of infection compared with those undergoing EI procedures (OR, 0.45; 95% CI, 0.25-0.29; P=.006) of the autologous reconstructions.
• Findings revealed that DTI and EI procedures had higher failure rates (EI and DTI techniques, 7.1%; pTRAM flap, 1.2%; fTRAM flap, 2.1%; DIEP flap, 1.3%; LD flap, 2.8%; and SIEA flap, 0%; P < .001).