M. Arabhkari4, S. Sandhu1, J.L. Semple2,4, M. Brown2,4, J. Escallon2,3,4, T.D. Cil3,4, D.W. Lim2,4 1NUI Galway, Galway, CONNAUGHT, Ireland 2Women’s College Hospital, Surgery, Toronto, ONTARIO, Canada 3University Health Network, Surgery, Toronto, ONTARIO, Canada 4University of Toronto, Toronto, ONTARIO, Canada
Introduction: There is a paucity of knowledge on the surgical outcomes after ambulatory mastectomy and immediate reconstruction. Our institution has been performing ambulatory mastectomy with immediate alloplastic reconstruction since 2015. Our primary objective was to evaluate the complication rate of ambulatory mastectomy with immediate alloplastic reconstruction to assess its feasibility and safety. Our secondary objective was to assess the impact of mastectomy type (nipple versus skin sparing) and implant location (subpectoral versus prepectoral) on complication rates.
Methods: We conducted a retrospective cohort study of all patients at our institution who underwent ambulatory mastectomy with immediate alloplastic breast reconstruction for either breast cancer or risk reduction between 2015 and 2021. We collected demographic data on age, ethnicity, smoking status and menopausal status. Clinical data include indication for mastectomy, type of mastectomy, prepectoral vs subpectoral reconstruction, implant type, and post-operative complications (e.g. infection, hematoma, skin or nipple necrosis, return to operating room, implant loss). Descriptive statistics were used to characterize the incidence of complications. A multivariable logistic regression model was used to determine the impact of mastectomy type and implant location on complication rates, with age, smoking status, and surgical indication as covariates. Statistical analysis was performed using SAS® OnDemand for Academics. P values < 0.05 were considered statistically significant.
Results: 343 women underwent ambulatory mastectomy with immediate breast reconstruction for breast cancer (171, 49.9%) or risk reduction (172, 50.1%). 177 (51.6%) women underwent skin-sparing mastectomy (SSM) and 166 (48.4%) underwent nipple-sparing mastectomy (NSM). The mean age was 48.8 (SD 10.5) for those having SSM and 41.4 (SD 10.0) for those having NSM. 254 (74.0%) had a subpectoral implant and 86 (25.1%) had a prepectoral implant. 67 (20%) of patients developed a post-operative complication. There was no interaction between mastectomy type and device location on complication rates (P = 0.9). Compared with NSM, women having SSM had a lower complication rate (OR 0.46, 95% CI 0.26 – 0.85, P = .01). The implant location (subpectoral versus prepectoral) did not impact complication rates (OR 0.75, P = 0.8). Younger age, smoking status and surgical indication also did not impact complication rates.
Conclusion: In our series, 80% of women undergoing ambulatory mastectomy with immediate alloplastic reconstruction for risk reduction or breast cancer did not experience a post-operative complication, underscoring its safety. Ambulatory mastectomy with immediate alloplastic reconstruction should be considered a standard for carefully selected patients.