Back to 2025 Resident Posters
Complication Profiles In Patients Undergoing Mastectomy And Alloplastic Breast Reconstruction: Does Previous Breast Surgery Play A Role?
Dustin T. Crystal, MD, Jane N. Ewing, BS, Mehdi S. Lemdani, BS, Zachary Gala, MD, Robyn B. Broach, PhD, Said C. Azoury, MD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: While outcomes of implant-based breast reconstruction (IBR) have been described, there is a paucity of literature documenting the outcomes of patients with prior breast surgery who subsequently undergo mastectomy with IBR. These patients are assumed to be at greater risk for delayed wound healing and mastectomy skin or nipple-areolar complex (NAC) necrosis. This study elucidates the outcomes of IBR comparing patients with and without prior breast surgery.
METHODS: A 2018-2021 single-institute, breast-level analysis examining IBR was performed. Postoperative complications were compared between patients with no prior breast surgery (NPBHx) and patients with either prior non-cancer breast surgery (PNCBS) or prior cancer-related breast surgery (PCBS). Subgroup analyses evaluated patients receiving nipple-sparing mastectomy and those with prior radiation.
RESULTS: A total of 1,912 breasts underwent IBR, with a median follow-up of 330 (IQR:118-672.5) days. Of these, 1,475 had NPBHx, 186 had PNCBS, and 251 had PCBS. Those with prior breast surgery had significantly higher post-operative delayed wound healing, seromas, hematomas, mastectomy skin necrosis, and NAC necrosis (Table 1). PCBS had significantly greater reoperations (OR 1.65, CI:1.22-1.23, p=0.001), readmissions (OR 1.77, CI:1.18-2.66, p=0.006), and implant/expander loss (OR 1.70, CI:1.21-2.39, p=0.002). Elevated rates of surgical complications persisted independent of radiation.
CONCLUSION: Prior breast surgery significantly increases postoperative IBR complications. These patients should be approached with heightened awareness and counseled on higher-than-average rates of NAC necrosis and implant loss.
Post-operative complications of patients undergoing IBR with or without prior breast surgery. | NPBHx (N=1475) | PNCBS (N=186) | PCBS (N=251) | Total (1912) | NPBHx vs PNCBS (p-value) | NPBHx vs PCBS (p-value) |
| Reoperations | 292 (19.9%) | 39 (21.0%) | 72 (29.0%) | 403 (21.2%) | 0.726 | 0.001 |
| Readmissions | 121 (9.2%) | 15 (8.1%) | 34 (13.7%) | 170 (8.9%) | 0.936 | 0.005 |
| Surgical Site Infection | 204 (13.9%) | 20 (10.8%) | 36 (14.3%) | 260 (13.6%) | 0.242 | 0.841 |
| Delayed wound healing | 171 (11.6%) | 29 (15.6%) | 41 (16.3%) | 241 (12.6%) | 0.002 | 0.001 |
| Seroma | 291 (19.8%) | 52 (28.0%) | 74 (29.5%) | 417 (21.9%) | 0.001 | 0.001 |
| Hematoma | 103 (7.0%) | 15 (8.1%) | 15 (6.0%) | 133 (7.0%) | 0.005 | 0.001 |
| Mastectomy Skin Necrosis | 119 (8.1%) | 20 (10.8%) | 21 (8.4%) | 160 (8.4%) | 0.003 | 0.001 |
| NAC Necrosis | 101 (6.9%) | 25 (13.4%) | 23 (9.2%) | 149 (7.8%) | 0.001 | 0.001 |
| Implant/Expander Loss | 192 (13.1%) | 18 (9.7%) | 51 (20.3%) | 261 (13.7%) | 0.192 | 0.002 |
Back to 2025 Resident Posters
