Reconstructive Trends After Tissue-Expander Loss in Breast Reconstruction
Kanad Ghosh, BA1, Jocellie Marquez, MD, MBA2, Kaitlin Monroig, BS1, Hunter Rogoff, BS1, Ellen Niu, BS1, William Marmor, BS1, Phoebe McAuliffe, BA1, Duc T. Bui, MD2, Tara L. Huston, MD, FACS2
1Stony Brook University School of Medicine, Stony Brook, NY, 2Stony Brook University Hospital Division of Plastic Surgery, Stony Brook, NY
Background: Tissue-expander breast reconstruction (TEBR) is the most common method of reconstruction following mastectomy. However, tissue-expanders not uncommonly result in complications which may necessitate removal. Though complications in TEBR have been studied at length, there is a paucity of data regarding the outcomes of patients after tissue-expander loss. In this study, we examine the eventual reconstructive pathways and associated factors of patients who required tissue-expander removal after infection.
Methods: This retrospective study examines patients undergoing breast reconstruction at a single institution. Patients included underwent mastectomy, immediate TEBR, and subsequent tissue expander loss. Patients who underwent autologous reconstruction after mastectomy or had successful TEBR were excluded. Patients were followed for an average of 7 years, with a minimum of 2 years and a maximum of 13 years.
Results: 674 TEBR patients were initially screened, of which 60 patients (8.9%) required tissue-expander removal due to complications, most commonly infection or skin necrosis. Thirty one of these patients (Group 1) did not complete reconstruction after initial tissue-expander loss, while the remaining 29 patients (Group 2) underwent either TEBR or autologous reconstruction after tissue-expander loss. Group 1 had a significantly higher mean BMI than Group 2 (32.61 ± 8.88 v.s. 28.69 ± 5.84, p=.049). and had more hypertensive patients than Group 2 (48.4% vs 27.6%, p=.098), though the latter was only approaching significance. Group 1 patients also lived further away from our institution than Group 2 (p=.052) which trended toward significance. There were otherwise no significant differences in age, smoking status, diabetes, radiation/chemotherapy history, time from initial reconstruction to expander loss, or number of complication related admissions between the two groups. Among the 29 patients in Group 2, 18 patients underwent a second TEBR (Group 2a) and 11 patients underwent autologous reconstruction (Group 2b). Patients in Group 2b had a significantly greater mean number of complication related admissions after revision (1.11 ± .323 vs 1.55 ± .688, p=.029), and also had higher occurrence of post-mastectomy radiation therapy (16.7% vs 45.5%, p=.092), though this was not significant. There were otherwise no differences between the two groups.
Conclusion: Our data demonstrate the trends in breast reconstruction decision making after initial tissue-expander loss. This study elucidates the factors associated with patients who undergo different reconstructive options. Further work is needed to delineate the specific reasons between the decision to pursue different reconstructive pathways among a larger cohort of patients.
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