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Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction
- Source :
- JAMA Surgery. 153:901
- Publication Year :
- 2018
- Publisher :
- American Medical Association (AMA), 2018.
-
Abstract
- IMPORTANCE: In breast reconstruction, it is critical for patients and surgeons to have comprehensive information on the relative risks of the available options. However, previous studies that evaluated complications were limited by single-center designs, inadequate follow-up, and confounding. OBJECTIVE: To assess 2-year complication rates across common techniques for postmastectomy reconstruction in a multicenter patient population. DESIGN, SETTING, AND PARTICIPANTS: This longitudinal, multicenter, prospective cohort study conducted from February 1, 2012, through July 31, 2015, took place at the 11 study sites associated with the Mastectomy Reconstruction Outcomes Consortium study. Eligible patients included women 18 years and older presenting for first-time breast reconstruction with at least 2 years of follow-up. Procedures evaluated included direct-to-implant (DTI) technique, expander-implant (EI) technique, latissimus dorsi (LD) flap, pedicled transverse rectus abdominis myocutaneous (pTRAM) flap, free transverse rectus abdominis myocutaneous (fTRAM) flap, deep inferior epigastric perforator (DIEP) flap, and superficial inferior epigastric artery (SIEA) flap. INTERVENTIONS: Postmastectomy breast reconstruction. MAIN OUTCOMES AND MEASURES: Development of complications, reoperative complications, and wound infections during 2-year follow-up. Mixed-effects logistic regression analysis controlled for variability among centers and for demographic and clinical variables. RESULTS: A total of 2343 patients (mean [SD] age, 49.5 [10.1] years; mean [SD] body mass index, 26.6 [5.7]) met the inclusion criteria. A total of 1525 patients (65.1%) underwent EI reconstruction, with 112 (4.8%) receiving DTI reconstruction, 85 (3.6%) pTRAM flaps, 95 (4.1%) fTRAM flaps, 390 (16.6%) DIEP flaps, 71 (3.0%) LD flaps, and 65 (2.8%) SIEA flaps. Overall, complications were noted in 771 (32.9%), with reoperative complications in 453 (19.3%) and wound infections in 230 (9.8%). Two years postoperatively, patients undergoing any autologous reconstruction type had significantly higher odds of developing any complication compared with those undergoing EI reconstruction (pTRAM flap: odds ratio [OR], 1.91; 95% CI, 1.10-3.31; P = .02; fTRAM flap: OR, 2.05; 95% CI, 1.24-3.40; P = .005; DIEP flap: OR, 1.97; 95% CI, 1.41-2.76; P
- Subjects :
- Adult
medicine.medical_specialty
Breast Implants
Mammaplasty
medicine.medical_treatment
Breast Neoplasms
030230 surgery
Transplantation, Autologous
Surgical Flaps
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
DIEP flap
medicine
Humans
Prospective Studies
Prospective cohort study
Mastectomy
Original Investigation
Postoperative Care
business.industry
Odds ratio
Surgery
Transplantation
030220 oncology & carcinogenesis
Regression Analysis
Female
Complication
Breast reconstruction
business
Subjects
Details
- ISSN :
- 21686254
- Volume :
- 153
- Database :
- OpenAIRE
- Journal :
- JAMA Surgery
- Accession number :
- edsair.doi.dedup.....c63d5d6fbd3683a230e34f721f4f5824