Predictors of postoperative complications and unplanned reoperations 90 days following immediate alloplastic breast reconstruction.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42385439.
- Also identified by DOI 10.1016/j.bjps.2026.06.007.
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Abstract
Implant-based breast reconstruction is common and may result in postoperative complications/unplanned reoperation within 90 days of surgery. We aimed to characterize postoperative complications and unplanned reoperations within 90 days of immediate alloplastic breast reconstruction and identify pre- and intraoperative factors that are independently associated with these outcomes. We retrospectively reviewed patients ≥18 years who underwent mastectomy and immediate alloplastic breast reconstruction at five institutions in our health system from July 2016 through February 2022. We abstracted patient demographics, surgical details, and 48-hour and 90-day postoperative complications/unplanned reoperations. We performed bivariate analyses and multivariate regressions to identify associations between 90-day postoperative complications/unplanned reoperations and patient/surgical factors. Significance was set at p<0.05. We included 1196 patients with median age of 51 years and median body mass index (BMI) of 24.9 kg/m<sup>2</sup>. Two hundred seventeen patients (18.1%) experienced 367 complications including infection (9.2%), mastectomy skin necrosis (6.0%), seroma (4.0%), and wound dehiscence (1.8%). One hundred fifty-three patients (12.8%) underwent unplanned reoperation [e.g., tissue expander/implant removal without replacement (6.9%) and debridement (6.7%)]. On multivariate analysis, autoimmune conditions (OR 2.00, 95% CI 1.05-3.83, p=0.036), prophylactic mastectomy (OR 1.74, 95% CI 1.06-2.84, p=0.027), bilateral mastectomy (OR 1.63, 95% CI 1.17-2.27, p=0.004), and BMI ≥30 kg/m<sup>2</sup> (OR 1.53, 95% CI 1.01-2.32, p=0.043) were associated with 90-day complications. Autoimmune conditions (OR 2.51, 95% CI 1.27-4.98, p=0.008) and prophylactic mastectomy (OR 2.11, 95% CI 1.23-3.62, p=0.007) were associated with unplanned reoperations. Autoimmune conditions, prophylactic mastectomy, bilateral procedures, and BMI ≥30 kg/m<sup>2</sup> were independent predictors of adverse postoperative outcomes. Patients with these factors may benefit from closer postoperative follow-up.