Bennett KG, et al. - In this longitudinal, multicenter, prospective cohort study, researchers evaluated 2-year complication rates across common techniques for postmastectomy reconstruction. They found significant differences across reconstructive procedure types for overall and reoperative complications, which is critically important information for women and specialists making breast reconstruction decisions.

Methods

• This investigation, conducted from February 1, 2012, through July 31, 2015, occurred at the 11 study sites related to the Mastectomy Reconstruction Outcomes Consortium study.
• Adult women presenting for first-time breast reconstruction with ≥ 2 years of follow-up were included eligible patients.
• Direct-to-implant (DTI) technique, expander-implant (EI) technique, latissimus dorsi (LD) flap, pedicled transverse rectus abdominis myocutaneous (pTRAM) flap, free transverse rectus abdominis myocutaneous (fTRAM) flap, deep inferior epigastric perforator (DIEP) flap, and superficial inferior epigastric artery (SIEA) flap were included evaluated procedures.
• Postmastectomy breast reconstruction was the main intervention.
• Main outcomes and measures analyzed were development of complications, reoperative complications, and wound infections during 2-year follow-up.
• Mixed-effects logistic regression analysis controlled for variability among centers and for demographic and clinical variables.

Results

• Inclusion criteria were met by 2,343 patients.
• An aggregate of 1,525 patients (65.1%) had EI reconstruction, with 112 (4.8%) receiving DTI reconstruction, 85 (3.6%) pTRAM flaps, 95 (4.1%) fTRAM flaps, 390 (16.6%) DIEP flaps, 71 (3.0%) LD flaps, and 65 (2.8%) SIEA flaps.
• They noted complications in 771 (32.9%) patients, with reoperative complications in 453 (19.3%) and wound infections in 230 (9.8%).
• Patients undergoing any autologous reconstruction type had significantly higher odds of developing any complication vs undergoing EI reconstruction 2 years postoperatively.
• All flap procedures were related to higher odds of reoperative complications vs EI techniques with the exception of LD flap reconstructions.
• Only patients undergoing DIEP flaps had significantly lower odds of infection vs undergoing EI procedures of the autologous reconstructions.
• Higher failure rates were observed in DTI and EI procedures.