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Does Pregnancy After Abdominally-based Autologous Breast Reconstruction Predict Incisional Hernia Repair? A National Claims Analysis
Jaclyn T. Mauch, MD, MBE, Zachary Eisner, BS, Leah Gudex, BS, Jeffrey H. Kozlow, MD, Paige L. Myers, MD, MPH.
University of Michigan, Ann Arbor, MI, USA.
PurposeRising breast cancer incidence and genetic testing have led younger women to undergo breast reconstruction. This trend, coupled with older average age of pregnancy, has resulted in women completing pregnancy after abdominally-based breast reconstruction (ABR). Our study utilizes national claims data to investigate whether pregnancy after ABR predicts incisional hernia rates (IHR).
MethodsCPT and ICD codes were collected to design a cohort of patients <40 years old who completed ABR between 2010 and 2019 through the PearlDiver national claims database and to identify patient characteristics, prior abdominal surgeries, post-op complications, pregnancy after ABR (pABR), and IHR. A chi-squared test was used for the Univariate analysis. Multivariate logistic regression was used to control for confounding covariates.
Results2,534 patients underwent ABR, 85 completed pABR with an average age at ABR of 34.6±34.6 and 32.2±4.5 for ABR-alone and pABR patients, respectively (p<0.001). There was no significant difference in comorbidities or post-ABR complications. Of the 85 pABR patients, 19 underwent c-section (22.4%) and 66 completed vaginal births (77.6%). ABR to birth averaged 32.1±19.8 months. The incidence of IHR was 3.5% (n=3) for pABR patients and 3.6% for ABR-alone patients (p=1). Patients undergoing c-section after ABR had a 15.8% (n=3) IHR rate, compared to 0% (n=0) for vaginal birth (p=0.010). In the multivariate model, c-section after ABR independently predicted IHR occurrence (p=0.02).
ConclusionsSurgeons should counsel patients considering future pregnancy that c-section after ABR would increase their IHR risk. If the patient ultimately desires ABR and future pregnancy, the surgeon and patient should discuss ideal timing.
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