Introduction:

Complications stemming from breast reconstruction can cause significant patient morbidity, the most important of which may be the delay of subsequent adjuvant antineoplastic therapies.  The compound effect of individual risk factors on the development of complications following tissue expander/implant reconstruction has not, however, been well delineated.  The purpose of this study was to develop a statistical model that combines preoperative, clinical risk factors in order to predict the likelihood of complications following tissue expander/implant breast reconstruction.

Methods:

From April 2002 to December 2003, 515 tissue expander/implant breast reconstructions were performed at a single tertiary cancer center.  A prospectively maintained clinical database was reviewed.  Nomogram predictor variables including: patient age, smoking status, body mass index, history of diabetes and/or hypertension, history of adjuvant chemotherapy and/or chest wall irradiation, and timing of reconstruction were recorded.  Overall complications as well as specific complications including reconstructive failure, skin flap necrosis, infection, seroma and hematoma, were evaluated.  Multiple predictive factors were analyzed using logistic regression modeling.   

Results:

The overall rate of complications following 515 tissue expander/implant breast reconstructions was 17.1%. Seventy-five percent of patients were non-smokers and 25.6%were smokers, of which 59.1% were ex-smokers (stopped smoking > 4 weeks prior to surgery).  Complications were 3 times more likely in smokers (OR 3.1,  95%CI: 1.9-5.0), 2 times more likely in obese patients (OR 2.1, 95%CI: 1.1-3.9), and 2 times more likely in patients with hypertension (OR 2.3,  95%CI: 1.2-4.8).  Reconstructive failure was 7 times more common in smokers (OR 7.1,  95%CI: 2.0- 25.3); and, mastectomy skin flap necrosis was 3 times more common in smokers than nonsmokers (OR 3.1,  95%CI: 1.7-5.9).  A nomogram that combines clinical risk factors was developed and validated.

Conclusions:

Smoking, obesity and hypertension are independent risk factors for postoperative complications following tissue expander/implant breast reconstruction.  A nomogram is developed that can be used to predict the probability of complications following tissue expander/implant breast reconstruction based on preoperative clinical predictors. This nomogram can provide important information to the surgeon and patient when evaluating overall risks and individualizing reconstructive options.