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Impact of Connective Tissue Disease on Outcomes Following Breast Surgery and Reconstruction
John Shuck, M.D., Ketan M. Patel, M.D., Brenton Franklin, M.D., Kenneth L. Fan, M.D., Lindsay Hannan, M.D., Maurice Y. Nahabedian, M.D..
Georgetown University Hospital, Washington, DC, USA.
Various patient-related factors can influence outcomes following breast surgery. Overall, complication rates range from 5-20% in breast surgery and reconstruction. Specifically though, the impact of connective tissue disease (CTD) on the healing and eventual outcome following breast surgery and/or reconstruction has not been well described.
A retrospective review was conducted of all patients who underwent breast surgery from 2005-2010. Patients were identified as having breast surgery and having an active diagnosis of a connective tissue disease. Patients were stratified into four cohorts including ablative surgery alone (AS), autologous reconstruction (AR), implant reconstruction (IR), and revision (RS). Four non-CTD control groups were also compiled for comparison. Primary outcome measures included major and minor post-operative complications in CTD and non-CTD patients. Logistic regression was utilized to examine the relationship between complications and type of surgery, CTD diagnosis, and immunosuppression. The a priori p-value was set at p < 0.05 and all tests were two-sided.
33 patients were isolated on whom 112 procedures were performed. Specific CTD diagnoses included; psoriasis/psoriatic arthritis (n=12), rheumatoid arthritis (n=10), lupus (n=4), scleroderma (n=3), sjogrens (n=2), mixed connective tissue disease (n =1), and seronegative polyarthritis (n=1). Patients with psoriatic arthritis had significantly increased chances of developing a minor complication as compared to other CTDs. Also, significantly lower rates of minor complications occurred among the AS cohort as compared to the other cohorts (OR=0.21; p=0.002). 19/33 (58%) patients were controlled with systemic treatment for CTD in the peri-operative period. Although patients on plaquenil had a significantly increased minor complication rate (OR=2.72; p=0.007), generally, patients on systemic therapy in the peri-operative period had significantly decreased likelihood of minor complications (OR=0.69; p=0.007). Fisher exact analysis demonstrated no difference in complications between CTD and non-CTD patients in the AS (p=0.78), AR (p=1.00), IR (p=0.46), and RS (p=0.21) groups. Adequate numbers were available for modeling and logistic regression analysis in the ablative and autologous reconstruction groups. When compared to controls, CTD patients had no significant difference in complications in the AS (OR=1.49, p=0.54) and AR (OR=1.01, p=0.99) groups.
Breast reconstruction among patients with connective tissue diseases can be performed safely with low peri-operative complication rates similar to patients without CTDs. Systemic therapy in the peri-operative period seems to decrease minor complication rates in most cohorts, and major complication rates are unaffected by CTD systemic therapy.
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