Background: Women who opt for breast reconstruction after mastectomy for cancer or cancer prophylaxis commit to additional post-operative physician visits and surgery. The time commitment for both the physician and the patient has not been critically examined. This information may impact the choice a women makes with regard to her reconstruction options.
Methods: We retrospectively reviewed a breast reconstruction database and the medical records of 300 women undergoing breast reconstruction over a nine year period at a single institution (1995-2004). Patients were grouped according to type of reconstruction: implant or autologous. Only patients with at least three months of post-operative follow-up were included. Data collected included returns to the operating room after the definitive reconstruction procedure and all post-operative visits.
Results: Three hundred women underwent 358 breast reconstruction operations. Eighty women had implant reconstructions, while 220 women had autologous reconstructions. The patient groups were similar in terms of age, race, body mass index, cancer stage, and history of pre and post-operative irradiation and post-operative chemotherapy. Mean follow-up was longer for the implant patients (37.9 months) compared to the autologous patients (28.1 months). Mean hospital stay was shorter (2.1 days, range 1-7) for patients with implants than patients with autologous reconstruction (4.9 days, range 2 – 36). (p < .001) Within 48 hours of the initial operation, 2.6% of the implant patients returned to the operating room for complications compared with 5.5% of the autologous reconstruction patients. (p = .41) The most common causes of unplanned return to the OR in this time frame for implant patients was hematoma and was tissue debridement for autologous patients. Within 30 days of the initial operation, 3.9% of the implant population returned to the operating room for complications compared to 10.5% of the autologous population. (p = .08) The most common causes of unplanned return to the OR in this time frame was expander rupture, seroma and skin necrosis for implant patients and hematoma, reanastomosis procedures, and flap removal for autologous patients. Over the longer term, 81.8% of the implant population returned to the operating room for revisional surgery compared to 61.8% of the autologous population (p = .001) Moreover, 74.4% of the implant reconstruction patients returned for cosmetic revisions compared to 47.7% of the autologous patients. (p < .001) Mean number of returns to the OR for those patients going back to the OR is 1.7 times for both the implant and autolgous groups. Mean number of post-operative office visits was 14.7 for implant patients (9.2 visits excluding visits for expansion) compared to 7.5 for the autologous reconstruction patients. (p < .001)
Conclusion: Overall, a higher percentage of patients undergoing implant reconstruction require additional surgery for revisions and cosmetics. However, there is no significant difference in the returns to the OR for unexpected complications for each patient population within either 48 hours or 2 months following the initial reconstruction. Of those patients going back to the OR for additional surgeries, the mean number of returns to the OR for both implant and autolgous patients is the same. Finally, implant-based breast reconstruction results in more office visits after the initial reconstruction than autologous breast reconstruction due to the expansion process. The additional time commitment and resources required for each type of reconstruction is an important consideration for women making their reconstruction choice and should be discussed with the patient as part of pre-operative counseling.