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, John Hill, BS1, Sourish Rathi, BE2, Tara Huston, MD, FACS3, Jason Ganz, MD3, Sami Khan, 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.
Hematomas following tissue expander-based immediate breast reconstruction (TE-IBR) pose a significant challenge during the recovery period. In this study, we aim to evaluate whether hematoma formation leads to subsequent complications and how management can impact final reconstructive goals.
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 removal was defined as permanent loss or replacement of the expander/implant. Hematoma size, management, transfusion requirement, reoperations, and final outcomes were recorded. Delayed TE-IBRs, autologous reconstructions and any hematomas occurring after another complication were excluded.
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 removal (50% vs. 6%, p<0.0001) compared to Group 2. There were no differences for any other complications. Patients with hematomas who required implant removal (Group 1a: n=13, 50%) were associated with significantly larger hematomas (290 mL vs. 129 mL, p=0.038) compared to those that did not (Group 1b: n=13, 50%).
69.2% (n=18) of hematomas underwent surgical intervention (Group 1c) compared to 30.8% (n=8) that were clinically managed (Group 1d). Group 1c 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 1d. Subsequent complications included infection, capsular contracture, wound dehiscence, seroma, and implant removal.
Lastly, 23.1% (n=6) of patients who developed a hematoma were on home anticoagulants (Group 1e) compared to 76.9% (n=20) no-anticoagulants (Group 1f). There were statistically significant differences in transfusion rates (50% vs. 0%, p=0.001) between Groups 1e and 1f, respectively. Differences in hematoma volume (330 mL vs. 169.33 mL, p=0.078), implant removal (83.33% vs. 40%, p=0.063), and successful TE-IBR outcomes (66.7% vs. 95%, p=0.057) approached significance between both groups.
Patients who develop a hematoma after TE-IBR are at significant risk for implant removal, with large hematoma volumes being a major factor. In addition, patients on home anticoagulants 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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