Time and Procedures Required to Complete Breast Reconstruction: A Single-Institution Review

Introduction: Breast reconstruction may require multiple procedures beyond the initial surgery. Estimates range from 2^[1],[2] to 6^[3] procedures required. The reconstructive course may stretch over months and even years.^[4] Previous studies of the number of procedures and amount of time required to complete breast reconstruction have been limited in the factors considered and have reached conflicting conclusions. The authors aimed to determine the number of procedures and length of time it took a large, diverse, population of women to complete breast reconstruction.

Methods: Women undergoing breast reconstruction since 2003 with follow up in our institution’s medical record system were reviewed. Reconstruction completion was defined by the last procedure a patient underwent, even if she did not undergo nipple/areolar reconstruction. Chi-squared and independent t-tests were used to identify variables associated with number of procedures and length of time required for reconstruction. Significantly associated (p<0.05) variables were used in regression analysis.

 

Results: Four hundred thirty three patients were included. Seventy-five patients with procedures pending at the end of follow-up were excluded. Patients underwent an average of 4.06±1.95 procedures (range 2-12) over 593±648 days. Marital status, ethnicity, occupational status, axillary dissection, radiation, chemotherapy, laterality, and reconstruction type were not associated with either number of procedures or length of time required.

In a linear regression predicting time required for reconstruction, higher BMI was associated with shorter time required for reconstruction (16.5 days per unit BMI increase, p=0.006) and undergoing nipple reconstruction or tattooing was associated with increased time (287 days extra, p<0.0001).

In a linear regression predicting number of procedures required for reconstruction, undergoing nipple or areola reconstruction (p<0.0001), dehiscence (p=0.033), seroma (p=0.030), implant exposure (p=0.001), hematoma (p<0.0001), partial flap loss (p<0.0001), implant infection (p<0.0001), and number of complications (p<0.0001) positively predicted increased number of operations. Nipple reconstruction or tattooing and partial flap loss were the strongest predictors, with 1.92 and 2.67 additional procedures associated with each respectively.

 

Conclusions: The patients in this study underwent a number of procedures falling between previous estimates. Contrary to prior reports, implant-based reconstruction did not appear to have an advantage over autologous reconstruction in either number of procedures or length of reconstruction.^2,3 Similarly, radiation exposure and chemotherapy were not associated with increased number of procedures as reported elsewhere.³