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Once is Rarely Enough: A Population-Based Study of Reoperations after Postmastectomy Breast Reconstruction

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Postmastectomy breast reconstruction (PMBR) aims to surgically restore a breast mound following mastectomy. However, additional surgical procedures after PMBR can lead to increased postsurgical morbidity and healthcare utilization. The primary purpose of our study was to determine the overall population-based reoperation rates following PMBR in Ontario, Canada.

Methods

We conducted a population-based retrospective cohort study that included women aged 18–65 years who underwent a prophylactic or therapeutic mastectomy with immediate or delayed PMBR between April 1, 2002 and March 31, 2008. Reoperations to the breast or donor site used for reconstruction were identified using the Ontario Health Insurance Plan billing codes submitted by general or plastic surgeons. Reoperations were categorized as anticipated, unanticipated major, unanticipated minor, or oncologic. Patients were followed from the date of their PMBR to March 31, 2013, or death.

Results

Overall, 3972 women underwent PMBR between April 1, 2002 and March 31, 2008. Among them, 3504 (88 %) underwent at least one reoperation during an average follow-up of 5.1 years. The median number of procedures per patient was two (mean 2.4, range 0–26). One of ten patients had three or more unanticipated major reoperations during the follow-up period.

Conclusions

Our results provide the first long-term population-level data on the current state of PMBR reoperation rates. The results from this study will inform patient-physician surgical decision-making and provide quantitative expectations of morbidity related to PMBR.

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References

  1. Cordeiro PG. Breast reconstruction after surgery for breast cancer. N Engl J Med. 2008;359(15):1590–601.

    Article  CAS  PubMed  Google Scholar 

  2. Garcia-Etienne CA, Forcelli D, Sagona A, et al. Breast reconstruction: a quality measure for breast cancer care? Breast. 2012;21(1):105–6.

    Article  CAS  PubMed  Google Scholar 

  3. Birkmeyer JD, Hamby LS, Birkmeyer CM, Decker MV, Karon NM, Dow RW. Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg. 2001;136(4):405–11.

    Article  CAS  PubMed  Google Scholar 

  4. Morris AM, Baldwin LM, Matthews B, et al. Reoperations as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg. 2007;245(1):73–9.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Zion SM, Slezak JM, Sellers TA, et al. Reoperations after prophylactic mastectomy with or without implant reconstruction. Cancer. 2003;98(10):2152–60.

    Article  PubMed  Google Scholar 

  6. Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109(7): 2265–74.

    Article  PubMed  Google Scholar 

  7. National Health System Information Centre. National Mastectomy and Breast Reconstruction Audit. www.hscic.gov.uk/…/clin-audi-supp-prog-mast-brea-reco-2011-rep1.pdf. Accessed 11 April 2015.

  8. Rusby JE, Waters RA, Nightingale PG, England DW. Immediate breast reconstruction after mastectomy: what are the long-term prospects? Ann R Coll Surg Engl. 2010;92(3):193–7.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Jiménez-Puente A, Prieto-Lara E, Rueda-Domínguez A, et al. Complications in immediate breast reconstruction after mastectomy. Int J Technol Assess Health Care. 2011;27(4):298–304.

    Article  PubMed  Google Scholar 

  10. Cordeiro PG, McCarthy CM. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications. Plast Reconstr Surg. 2006;118(4):825–31.

  11. Sullivan SR, Fletcher DR, Isom CD, Isik FF. True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr Surg. 2008;122(1):19–28.

    Article  CAS  PubMed  Google Scholar 

  12. Potter S, Brigic A, Whiting PF, et al. Reporting clinical outcomes of breast reconstruction: a systematic review. J Natl Cancer Inst. 2011;103(1):31–46.

    Article  CAS  PubMed  Google Scholar 

  13. Boughey JC, Hoskin TL, Hartmann LC, Johnson JL, Jacobson SR, Degnim AC, Frost MH. Impact of reconstruction and reoperation on long-term patient-reported satisfaction after contralateral prophylactic mastectomy. Ann Surg Oncol. 2015;22(2):401–8.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Singh NK, Reaven NL, Funk SE. Cost comparison of immediate one-stage and tissue-expander breast reconstructions after mastectomy in commercially insured patients. Manag Care. 2013;22(3):36–43.

    PubMed  Google Scholar 

  15. Eom JS, Kobayashi MR, Paydar K, Wirth GA, Evans GR. The number of operations required for completing breast reconstruction. Plast Reconstr Surg Glob Open. 2014;2(10):e242.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The authors thank Kimberley Fernandes (Institute for Clinical Evaluative Sciences) for her contribution towards the acquisition of data. The authors also acknowledge that this study is supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the MOHLTC is intended or should be inferred. Canadian Breast Cancer Foundation Ontario Region, Research Project Funding (T.Z. and N.B.) and the Physicians’ Services Inc. Foundation, Health Research Grant (A.R., N.B. and T.Z.).

Disclosures

Canadian Breast Cancer Foundation, Ontario Fellowship program – salary support (A.R.). Career Development Award from the American Society of Clinical Oncology (T.Z).

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Amanda Roberts MD, MPH

  2. Division of General Surgery, St. Michael’s Hospital, Toronto, ON, Canada

    Nancy Baxter MD, PhD

  3. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Ximena Camacho MMath & Cindy Lau MPH

  4. Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, ON, Canada

    Toni Zhong MD, MHS

Authors
  1. Amanda Roberts MD, MPH
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  2. Nancy Baxter MD, PhD
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  3. Ximena Camacho MMath
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  4. Cindy Lau MPH
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  5. Toni Zhong MD, MHS
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Corresponding author

Correspondence to Amanda Roberts MD, MPH.

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Roberts, A., Baxter, N., Camacho, X. et al. Once is Rarely Enough: A Population-Based Study of Reoperations after Postmastectomy Breast Reconstruction. Ann Surg Oncol 22, 3302–3307 (2015). https://doi.org/10.1245/s10434-015-4716-8

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  • DOI: https://doi.org/10.1245/s10434-015-4716-8

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