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Preoperative Leukopenia Is Associated with Tissue Necrosis Following Two-Stage Implant-Based Breast Reconstruction
Emma Lascar
*1, Olivia Becker
2, Larissa Iraj
2, Rebecca Suydam
1, Patricia Fuentes
1, Sahil Sharma
1, Peter J. Taub
1, Peter W. Henderson
11Division of Plastic and Maxillofacial Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; 2Icahn School of Medicine at Mount Sinai, New York, NY
BACKGROUND: Preoperative leukopenia predicts postoperative complications across surgical specialties. Despite widespread use of myelosuppressive therapy in breast cancer, white blood cell (WBC) count has not been evaluated in implant-based breast reconstruction risk models, which instead emphasize smoking, BMI, radiation, and perfusion-related factors. This study evaluated whether preoperative WBC count and leukopenia predict complications in two-stage IBR.
METHODS: A single-institution retrospective review of patients undergoing two-stage IBR was conducted. Preoperative WBC values obtained within 30 days prior to tissue expander (TE) placement and implant exchange were recorded. Leukopenia was defined as WBC <4.0 × 10^3/µL. Ninety-day outcomes included tissue necrosis, surgical site infection (SSI), dehiscence, seroma, and reoperation. Fisher's exact and Mann-Whitney U tests compared categorical and continuous variables, respectively. Multivariable logistic regression evaluated the independent association between WBC and tissue necrosis, adjusting for age and BMI (p<0.05).
RESULTS: Among 106 patients (mean age 53.3±12.3 years, mean BMI 27.3±5.6), 50.0% underwent bilateral reconstruction. Leukopenia was present in 13.7% of patients at TE placement and 15.6% at implant exchange. At TE placement, leukopenia was associated with a tenfold increase in necrosis rate (62.5% vs. 6.3%; OR 24.6; p=0.0005). This association persisted at implant exchange (42.9% vs. 8.1%; OR 8.5; p=0.042). Modeled continuously, each 1x10^3/µL increase in WBC was associated with a 46% reduction in necrosis odds (OR 0.54, 95% CI 0.34-0.87; p=0.011), remaining significant after adjustment for age and BMI (OR 0.53; p=0.012).
CONCLUSIONS: Preoperative leukopenia independently predicts tissue necrosis in IBR. A WBC <4.0×10^3/µL identified patients at significantly elevated necrosis risk independent of age and BMI. Incorporating WBC into preoperative risk stratification may improve patient selection, reconstruction timing, and perioperative optimization in patients receiving myelosuppressive therapy.
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