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The Impact Of Breast Cancer Type, Staging, And Treatment On Free Flap Breast Reconstruction Complications
Daniel M. Mazzaferro, MD, MBA1, Martin P. Morris, MBE1, Ankoor Talwar, MBA1, Michaela Hitchner, BS1, Adrienne N. Christopher, MD2, Harrison Davis, BS3, Jared M. Shulkin, BS1, Jonathan Walsh, BS1, Robyn B. Broach, PhD1, Joseph M. Serletti, MD, FACS1.
1University of Pennsylvania, Philadelphia, PA, USA, 2University of Pennsylvania and Thomas Jefferson University Hospital, Philadelphia, PA, USA, 3University of Pennsylvania and Temple University School of Medicine, Philadelphia, PA, USA.

PURPOSE: The impact of breast cancer staging and treatment on clinical outcomes after autologous free-flap breast reconstruction (ABR) is not well-established. This retrospective review aims to determine if higher breast cancer staging, hormone receptor positivity, and history of venous thromboembolism (VTE) are associated with greater flap vascular complications after ABR.
METHODS: A retrospective review was conducted examining patients who underwent ABR from 2009-2019. Breast cancer staging, types and treatments were collected. Intraoperative and postoperative complications related to vascular compromise, including intraoperative congestion, postoperative take back for flap concern, and flap loss, were analyzed using chi-squared test.
RESULTS: 1,615 patients underwent free-flap ABR during the study period and were included. Patients with estrogen receptor (ER) positive breast cancer have an increased risk of vascular complication compared to ER-negative cancer (6.0% vs. 2.6% for take back, p=0.033; and 13.7% vs. 7.4% for overall vascular compromise, p=0.006; Table). Patients with human epidermal growth factor receptor 2 (HER2) negative breast cancer were more likely to have vascular compromise than HER2-positive (12.4% vs. 7.4%, p=0.035). Breast cancer staging, progesterone receptor, triple-negative, and neoadjuvant treatment were not associated with ABR vascular complications.
CONCLUSION:
We found that ER-positive breast cancer, HER2-negative breast cancer, and history of VTE were independent risk factors for ABR vascular complications. Breast cancer stage and neoadjuvant treatments were not associated with increased free-flap vascular complications after ABR.


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