Almost one-third of women who underwent reconstructive breast implantation after mastectomy had at least one short-term complication in the chest or breast area, with one in five women requiring additional surgery, according to a study in the December issue of Archives of Surgery, one of the JAMA/Archives journals.
Breast cancer is the most common malignancy among women in North American, Europe, Australia, New Zealand and some parts of South America, according to background information in the article. Women with breast cancer and their physicians may face several choices in the course of treatment, including whether to remove the breast (mastectomy) or undergo breast-conserving therapies, when and whether to reconstruct the breast following mastectomy and what materials to use in doing so. Surgeons performing postmastectomy reconstruction can form the new breast from flaps of skin and other tissue from the woman's body (autologous tissue) or insert an implant, and sometimes use both techniques at once. Many women choose implants alone because the procedure is simpler and requires less operation time than those using autologous tissue, and it can preserve the color of the skin of the breast and possibly some of its sensitivity.
Trine F. Henrikson, M.D., of the Danish Registry for Plastic Surgery of the Breast (DPB), Copenhagen, Denmark, and colleagues analyzed data from 574 women in the registry who underwent postmastectomy breast reconstruction between June 1, 1999, and July 24, 2003. The patients' surgeons reported the dates and details of each implantation and filled out follow-up forms when the women returned for subsequent visits. The women, ages 21 to 78 years with a mean (average) age of 51 years, were monitored through Sept. 15, 2003.
Following their first implantation, 31 percent of the women developed at least one adverse event, 16 percent developed two complications and 8 percent experienced three or more during the course of the study. The most common complications were infection, blood clotting, seroma (collection of serum in the tissues) and skin perforation. Forty-nine percent of these complications occurred within three months and 67 percent within six months.
Additional surgery was required for 21 percent of the women, while 3 percent underwent additional nonsurgical treatment. Surgery was most often needed to correct asymmetry of the breasts, displacement of the implant or capsular contracture, when the capsule-like scar tissue that forms around the implant tightened and hardened. "Surgical or medical intervention is commonly required during the reconstructive course, but reconstruction failure (loss of implant) is rare," the authors report.
The researchers also examined data on the 302 women in the study who had reimplantations, usually to exchange or replace the existing implant. These women had similar rates of complications--36 percent of them developed at least one adverse event and 21 percent required additional surgery.
"When evaluating benefits and risks associated with breast reconstruction, the surgeon and patient should consider that the reconstructive process often requires additional surgical interventions to treat local complications or to achieve the desired cosmetic result," the authors conclude. "Detailed information on the likelihood of local complications associated with the given indication (cosmetic vs. reconstructive) should be an essential part of adequate informed consent for women seeking breast implantation."
(Arch Surg. 2005;140:1152-1159. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was funded by the International Epidemiology Institute, which received unrestricted funding for the DPB from the Dow Corning Corporation, Midland, Mich.
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