Bletsis, P.P. (Panayotis) (2017) A Single-Center Evaluation of Prophylactic Mastectomy and Reconstruction Outcomes: The Benefit of Autologous Reconstructions. thesis, Medicine.
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Abstract
Background and Purpose: Over the last decade we have seen a 12% increase in prophylactic mastectomies (PM) annually. Indications for PM vary and include genetic predisposition or strong family history. At our institution, autologous flap reconstruction is the favored method of post-mastectomy breast reconstruction. However, evidence suggests that rates of PM and breast reconstructions may vary between institutions; it therefore becomes crucial to evaluate the complication profile within this patient group. Previous literature has reported reoperation rates in around 50-65% of risk reducing mastectomies. Complication rates in this cohort still have yet to be standardized. In this study, we reviewed post-operative outcomes in women undergoing PM and breast reconstruction at our institution. Methods: A retrospective chart review of consecutive women who underwent PM - bilateral (BPM) or contralateral (CPM) - between 2010 and 2015 at a single academic institution was performed. Patients with malignancy on final pathology were excluded or added to the CPM cohort. Patient demographics, comorbidities, type of mastectomy and reconstruction, intraoperative and postoperative outcomes were collected and analyzed. Postoperative complications were grouped into two categories (minor and major) utilizing the Clavien-Dindo Classification for Surgical Complications. We compared complication rates of autologous and prosthetic reconstructions, contralateral PM (CPM) outcomes with therapeutic breast cancer mastectomy (UM) outcomes in single patients, as well as independently evaluated outcomes in patients undergoing CPM and BPM. Patients undergoing all types of reconstructions were included in the univariate and multivariate model. Models were built looking at both independent risk factors for minor and major complications. A p < .05 was considered significant for inclusion into multivariate model. Results: We identified 351 patients (430 breasts), 272 patients (272 breasts) underwent CPM and 79 patients (158 breasts) underwent BPM, with a mean follow up time of 39.4 months. Patients undergoing PM had an average age of 48.7 years. The average BMI was 27.6 kg/m2. Most patients at our institution underwent autologous reconstruction of the breast but there was no significant difference between the two PM groups (p = .397), however significant differences were seen between the number of tissue expander based reconstructions (p = .014) and directto- implant (p < .001). The overall complication rate was 16.3%; minor complications 15.1% and major 6.5%. CPM, UM (p = .821) and BPM (p = .641) complication rates were not significantly different. Autologous reconstructions had a significantly lower incidence of minor postoperative complications (11.2% vs. 18.8%, p = .036), breast infection (1.9% vs. 13.1%, p < .001) and breast seroma (2.3% vs. 7.4%, p = .018) than prosthetic reconstructions. Risk factors for minor or major complications included: age (≥65), obesity, ASA class (≥3), smoking, hypertension, anxiety, tissue expander (+ADM), and implant-only reconstructions. Conclusion: Prophylactic mastectomy and reconstruction rates are rising and represent an important component of the management of those women with a high risk of developing breast cancer. However, it is important that patients and clinicians make decisions based on knowledge of the complication profile when undertaking surgery on a normal breast. In our study, autologous reconstruction had a better complication profile than prosthetic reconstruction. Clinicians can use this information to aid pre-operative counselling of women considering prophylactic mastectomy and reconstruction.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty Supervisor: and Lei, Prof. Dr. Berend Van der |
| Supervisor name: | External Supervisor: and Lin, Associate Prof. Dr. Samuel J. and Department of Surgery, Division of Plastic and Reconstructiv and of Beth Israel Deaconess Medical Center of Harvard Medical S |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2277 |
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