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A Comparison of Surgical Complications Between Immediate Breast Reconstruction and Mastectomy: The Impact on Delivery of Chemotherapy—An Analysis of 391 Procedures

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To compare the postoperative complications after immediate breast reconstruction (IBR) versus mastectomy alone and to examine the impact on the delivery of chemotherapy.

Methods

In this prospective series, there were 391 consecutive women who underwent mastectomy (243 mastectomy alone and 148 mastectomy and IBR). The outcome measures were complications (within 3 months after surgery) and time to adjuvant chemotherapy.

Results

Compared to the IBR group, patients in the mastectomy alone group were significantly older (P < 0.0001), smokers (P = 0.007) and less likely to have had previous radiation or lumpectomy (P < 0.0001). Overall, the complication rate was significantly greater in the IBR group than mastectomy alone (27.0% vs. 15.6%, P = 0.009). Univariate analyses revealed that mastectomy with IBR [odds ratio (OR) = 2, 95% confidence interval (CI) 1.21–2.30]; bilateral procedure (OR = 1.84, 95% CI 1.07–3.16); previous radiotherapy (OR = 2.4, 95% CI 1.29–4.47); and previous lumpectomy (OR = 1.84, 95% CI 1.11–3.03) were significant predictors of increased complications. With multivariable analysis, none of these variables were significantly associated with increased complications. 106 patients received adjuvant chemotherapy; median time from mastectomy to chemotherapy was 6.8 (0.71–15) weeks in the mastectomy alone group (n = 96) compared to 8.5 (6.3–11) weeks in the IBR group (n = 10) (P = 0.01).

Conclusions

Although the incidence of overall and major postoperative complications was higher after IBR than mastectomy alone, there were no significant relationships in the multivariable analysis. IBR was associated with a modest increase in time to chemotherapy that was statistically but not clinically significant.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

    Toni Zhong MD & Stefan O. P. Hofer MD

  2. Department of Surgical Oncology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

    David R. McCready MD

  3. Department of Epidemiology and Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada

    Lindsay M. Jacks MD

  4. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Francis E. Cook MD

  5. Departments of Surgery and Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Nancy Baxter MD

  6. Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada

    Nancy Baxter MD

Authors
  1. Toni Zhong MD
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  2. Stefan O. P. Hofer MD
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  3. David R. McCready MD
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  4. Lindsay M. Jacks MD
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  5. Francis E. Cook MD
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  6. Nancy Baxter MD
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Corresponding author

Correspondence to Toni Zhong MD.

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Zhong, T., Hofer, S.O.P., McCready, D.R. et al. A Comparison of Surgical Complications Between Immediate Breast Reconstruction and Mastectomy: The Impact on Delivery of Chemotherapy—An Analysis of 391 Procedures. Ann Surg Oncol 19, 560–566 (2012). https://doi.org/10.1245/s10434-011-1950-6

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  • DOI: https://doi.org/10.1245/s10434-011-1950-6

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