M. Lazar1, C. Silvestri1, I. Le1, S. Weingarten1, I. Chervoneva1, M. Jenkins1, S. Copit1, P. Greaney1, T. Tsangaris1, A. Berger1 1Thomas Jefferson University Hospital,Philadelphia, PA, USA
Introduction: Complications following mastectomy with breast reconstruction can lead to delays in adjuvant therapy for breast cancer. Common complications include need for extended antibiotics, seroma aspirations, skin necrosis, and early tissue expander removal. Early removal of a tissue expander is the most devastating. We sought to identify risk factors for early tissue expander removal.
Methods: After obtaining IRB approval, we identified patients who underwent mastectomy over a five year period from 1/1/2010 to 12/31/2015. Ultimately, we found 397 patients who had a mastectomy with reconstruction. Age, race, body mass index (BMI), as well as history of hypertension, smoking and diabetes were recorded. The patient charts were reviewed for cancer stage, receipt of neoadjuvant chemotherapy, type of reconstruction, type of mastectomy (unilateral vs. bilateral), and early removal of tissue expander (< 180 days). Univariate and multivariate analyses were performed with p<0.05 being considered significant.
Results: The average age and BMI were 50.5 years old and 28.0. There were 374 patients who underwent mastectomy with tissue expander reconstruction (23 patients had immediate reconstruction with autologous tissue only). 237 patients had expander only reconstruction and 29 of them (12.2%) had early removal. 137 patients had expander + tissue (latissimus flap) and 9 of them (6.6%) had early removal. This difference between early removal rates was not statistically significant between the two groups (p=0.11). There was a significant difference in BMI between patients with and without early expander removal (30.5 vs. 27.7, p=0.014). There were 105 patients (28.1%) who underwent neoadjuvant chemotherapy in our cohort; this therapy was not associated with a significant increase in early expander removal (12.4% vs. 9.3%, p=0.45). Additionally, there was no significant difference between early tissue expander removal and mastectomy type (unilateral vs. bilateral, p=0.48), diabetes (p=0.15), hypertension (p=0.56), type of breast cancer (p=0.33), T-stage (p=0.95) and N-stage (p=0.55). Although it was not statistically significant, the early removal rate was 15.5% in smokers versus 8.6% in non-smokers (p=0.09).
Conclusion: Elevated BMI is a risk factor for early tissue expander removal. While not statistically significant, smoking may also contribute to early expander removal. These data should be used to counsel patients concerning the risks of surgery.