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2010 Annual Meeting Abstracts

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Skin sparing mastectomy with immediate versus delayed breast reconstructive surgery. Which has less risk?
*Husain M A Abbas, *Robert A Brenes, *Beth A Sieling, Stanley J Dudrick, *J Alexander Palesty
Saint Mary's Hospital, Waterbury, CT

Objective: Skin sparing mastectomy (SSM) with immediate or delayed breast reconstructive surgery (BRS) has led to improved cosmetic outcomes, positive impact on psychosocial health, better acceptance and improved adaptation after total mastectomy procedures. The aim of this study is to identify risk factors which may lead to increased local wound complications and potentially lead to flap loss in this group of patients.
Design: Retrospective chart review of patients undergoing SSM between the years of 1999 and 2009.
Setting: Community teaching hospital with university affiliation.
Patients: 316 patients who underwent SSM with immediate or delayed BRS for breast cancer.
Main Outcome Measures: Demographics, co-morbidities, 30 day hematoma and seroma formation, flap loss due to necrosis, implant loss, wound dehiscence and wound infection.
Results: Of 316 patients, 232 (73.4%) underwent SSM with immediate BRS and 84 (26.6%) underwent SSM with delayed breast reconstruction. An increased overall complication rate was associated with SSM with immediate BRS compared with delayed BRS, 13.4% vs 10.7%, respectively (p<0.05). Cellulitis and seroma/hematoma formation, followed by flap necrosis, were the most common complications. Six implants were necessarily removed. Risk factors influencing complications included pre/post-operative radiation therapy and co-morbidities, i.e.diabetes mellitus, hypertension, and smoking (p <0.05). Age was not a statistically significant factor related to incidence of complications.
Conclusions: Skin-sparing mastectomy with immediate reconstruction is a viable option which must be discussed with patients prior to undergoing mastectomy with reconstruction for breast carcinoma. An increased incidence in local wound complications is associated with immediate reconstruction compared with delayed reconstruction. The potential for, and incidence of, flap loss and expander/implant removal should be discussed pre-operatively with patients who have specific co-morbidities and/or peri-operative radiation.

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