Obesity and smoking increase risk of serious complications after immediate breast reconstruction
Factors such as smoking and obesity increase the odds of early implant loss in women who undergo mastectomy and immediate breast reconstruction with implants. In addition, the study authors proposed a unique risk-scoring tool that allows surgeons to better counsel patients preoperatively about their predicted risk for complications.
“The goal of our study was really to determine which patients are at greatest risk for experiencing significant complications with their implants in the first 30 days after breast reconstruction, with the hope that it will allow practicing surgeons, including reconstructive surgeons, an opportunity to better tailor preoperative risk counseling and improve patient selection,” said lead study author John P. Fischer, MD, a plastic surgery resident at the Perelman School of Medicine at the Hospital of the University of Pennsylvania in Philadelphia. The study was published in the Journal of the American College of Surgeons (2013; doi:10.1016/j.jamcollsurg.2013.07.389).
Breast reconstruction using implants is one of two surgical techniques available to women who want to rebuild the shape of their breasts following mastectomy. (Autologous reconstruction, in which surgeons use a woman's own tissue that is often taken from the abdomen, is the other main technique.) An implant reconstruction procedure—which requires a less-invasive operation—commonly involves placement of an expandable implant that is sequentially filled and then replaced at a second stage with a permanent implant to reconstruct breast tissue that's removed during a mastectomy.
In an effort to characterize which perioperative risk factors are associated with 30-day implant loss (the unplanned removal of an implant for any reason) after immediate breast reconstruction, researchers analyzed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database, which measures the quality of surgical care in private sector hospitals.
This analysis included 14,585 women age 40 to 60 years who had undergone immediate breast reconstruction. Consistent with previous studies that indicate how factors such as smoking and obesity affect the ability to heal after surgical procedures, the study results showed that smoking makes a woman's risk of early implant loss three times higher, and obesity confers a two to three times greater risk of early implant loss.
“One of the novel findings in our study is that it is not just obesity, but it is a state of progressive obesity that is associated with poorer outcomes,” Fischer said. “The more severe the state of obesity, the higher their risk of this complication.”
Other factors associated with a greater chance of complications during the early postoperative period included age (being older than 55 years) and operative risk factors such as bilateral reconstruction (having two implants) and direct-to-implant reconstruction, whereby women undergo a one-stage procedure, in which patients undergo mastectomy and then immediate permanent implant placement.