Assessing First and Multiple Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Reconstructions in Women with Breast Cancer
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
2.2. Exposure of Interest
2.3. Outcome of Interest
2.4. Radiotherapy
2.5. Covariates of Interest
2.6. Statistical Analysis
3. Results
3.1. Overall
3.2. Reoperation
3.3. Stratified Analysis by Reconstruction Type
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
IBR | Immediate Breast Reconstruction |
RORJ | Return to OR |
HR | Hazard Ratio |
CI | Confidence Interval |
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Immediate Breast Reconstruction | Delayed Breast Reconstruction | SMD 2 | |||
---|---|---|---|---|---|
n = 18,276 | 78.4% | n = 5025 | 21.6% | ||
Patient Characteristics | |||||
Age, Percentiles (25th 50th 75th) | 43, 50, 59 | 45, 53, 61 | −0.1889 | ||
Race/Ethnicity | |||||
Non-Hispanic White | 10,236 | 56.0% | 2855 | 56.8% | |
Black | 1485 | 8.1% | 372 | 7.4% | |
Hispanic | 3518 | 19.3% | 1165 | 23.2% | |
Asian | 2780 | 15.2% | 565 | 11.2% | |
Missing/Other | 257 | 1.4% | 68 | 1.4% | |
BMI, in kg/m2 (category) | −0.2560 | ||||
<18.5 | 202 | 1.1% | 43 | 0.9% | |
18.5–24.4 | 7114 | 38.9% | 1404 | 27.9% | |
25.0–29.4 | 6279 | 34.4% | 1814 | 36.1% | |
30.0–39.4 | 4380 | 24.0% | 1632 | 32.5% | |
≥39.5 | 298 | 1.6% | 124 | 2.4% | |
Unknown | 3 | 0.0% | 8 | 0.2% | |
Smoking | 0.2522 | ||||
Never | 13,452 | 73.6% | 3393 | 67.5% | |
Yes | 217 | 1.2% | 39 | 0.8% | |
Quit | 4524 | 24.8% | 1569 | 31.2% | |
Other/Missing | 83 | 0.4% | 24 | 0.5% | |
Hospital Characteristics | 0.1219 | ||||
Hospital Region | |||||
Hawaii | 516 | 2.8% | 256 | 5.1% | |
Northern California | 7727 | 42.3% | 1971 | 39.2% | |
Northwest | 1188 | 6.5% | 231 | 4.6% | |
Southern California | 8845 | 48.4% | 2567 | 51.1% | |
Bilateral Same-Day Surgery (yes) | 12,512 | 68.5% | 2393 | 47.6% | 0.4162 |
Year of Mastectomy 3 | 0.3944 | ||||
2010 | 830 | 61.7% | 515 | 38.3% | |
2011 | 997 | 65.6% | 524 | 34.5% | |
2012 | 1104 | 69.7% | 479 | 30.3% | |
2013 | 1302 | 72.9% | 484 | 27.1% | |
2014 | 1353 | 75.0% | 450 | 25.0% | |
2015 | 1586 | 78.7% | 430 | 21.3% | |
2016 | 1495 | 78.2% | 417 | 21.8% | |
2017 | 1540 | 80.7% | 369 | 19.3% | |
2018 | 1691 | 81.9% | 375 | 18.2% | |
2019 | 1663 | 83.3% | 334 | 16.7% | |
2020 | 1418 | 82.2% | 308 | 17.8% | |
2021 | 1799 | 87.8% | 250 | 12.2% | |
2022 | 1498 | 94.3% | 90 | 5.7% | |
ASA Classification | −0.1524 | ||||
1–2 | 15,347 | 84.2% | 4092 | 81.4% | |
3–5 | 2682 | 14.5% | 838 | 16.7% | |
Missing | 247 | 1.3% | 95 | 1.9% | |
Length of Stay (days) (mean, std) | 1.3, 1.5 | 1.2, 2.1 | 0.0150 | ||
Radiotherapy (yes) | 6425 | 35.2% | 1881 | 37.4% | −0.0455 |
Reconstruction Type 4 | |||||
Expander with or without Additional Reconstruction (yes) | 13,204 | 72.3% | 2561 | 51.0% | 0.4485 |
Expander with no Additional Reconstruction (yes) | 1198 | 6.6% | 199 | 4.0% | 0.1165 |
Single-Stage Reconstruction Procedure 4 | |||||
Flap (yes) | 2179 | 11.9% | 1520 | 30.3% | −0.4610 |
Direct-to-Implant Reconstruction (yes) | 2893 | 15.8% | 944 | 18.8% | −0.0782 |
Flap plus Implant (yes) | 2168 | 11.9% | 641 | 12.8% | −0.0272 |
Two-Stage Reconstruction | |||||
Expander-to-Flap Reconstruction (yes) | 1004 | 5.5% | 148 | 3.0% | 0.1270 |
Expander-to-Implant Reconstruction (yes) | 11,002 | 60.2% | 2214 | 44.1% | 0.3274 |
Elixhauser Comorbidities | Immediate Breast Reconstruction (IBR) | Delayed Reconstruction | SMD * | ||
---|---|---|---|---|---|
n = 17,643 | 78.3% | n = 4889 | 21.7% | ||
No. of comorbidities | 0.082 | ||||
0 | 5787 | 32.8% | 1379 | 28.2% | |
1 | 5328 | 30.2% | 1594 | 32.6% | |
2 | 3599 | 20.4% | 1002 | 20.5% | |
3 | 1553 | 8.8% | 533 | 10.9% | |
4 | 829 | 4.7% | 249 | 5.1% | |
5 or more | 547 | 3.1% | 132 | 2.7% | |
Alcohol Abuse | 194 | 1.1% | 73 | 1.5% | 0.040 |
Anemia | 1535 | 8.7% | 381 | 7.8% | 0.038 |
Congestive Heart Failure | 159 | 0.9% | 15 | 0.3% | 0.081 |
Depression | 1606 | 9.1% | 455 | 9.3% | 0.010 |
Diabetes Mellitus | 2329 | 13.2% | 694 | 14.2% | 0.047 |
Electrolyte/Fluid Disorder | 582 | 3.3% | 132 | 2.7% | 0.036 |
Peptic Ulcer Disease | 35 | 0.2% | 0 | 0.0% | 0.055 |
PVD | 776 | 4.4% | 156 | 3.2% | 0.058 |
PCD | 71 | 0.4% | 10 | 0.2% | 0.028 |
Psychosis | 1006 | 5.7% | 352 | 7.2% | 0.071 |
Renal Insufficiency | 582 | 3.3% | 93 | 1.9% | 0.090 |
Valvular Disease | 300 | 1.7% | 54 | 1.1% | 0.047 |
Breast Reconstruction Type | Adjusted HR (95% CI) | ||
---|---|---|---|
Immediate | Delayed (Ref) | ||
1st Reoperation | Cumulative Incidence (95% CI) | ||
Overall %, (95% CI) | 33.04% (32.36–33.73) | 31.72% (30.44–33.03) | 1.18 (1.12–1.25) 1 |
1 year | 21.29% (20.69–21.90) | 21.89% (20.77–23.07) | |
3 years | 29.27% (28.58–29.97) | 28.30% (27.06–29.58) | |
5 years | 31.67% (30.95–32.41) | 29.89% (28.61–31.21) | |
10 years | 36.37% (35.48–37.29) | 33.15% (31.72–34.61) | |
All Reoperations 3 | 1.00 (0.95–1.04) 2,3 |
Breast Reconstruction Type | ||||||||
---|---|---|---|---|---|---|---|---|
Immediate | Delayed (Ref) | |||||||
n= | Reoperations | n= | Reoperations | 1st Reoperation | All Reoperations | |||
1st (%) | Mean (±SD) | 1st (%) | Mean (±SD) | HR 1 (95% CI) | HR 2,3 (95% CI) | |||
Incomplete Reconstruction with Expander | ||||||||
Expander | 1198 | 652 (52.42) | 0.80 ± 0.91 | 199 | 70 (35.18) | 0.47 ± 0.77 | 1.82 (1.43–2.34) | 1.69 (1.36–2.10) |
Single-Stage Reconstruction | ||||||||
Autologous | 2179 | 995 (45.66) | 0.81 ± 0.93 | 1520 | 639 (42.02) | 0.82 ± 0.99 | 1.19 (1.07–1.31) | 1.09 (1.07–1.18) |
Direct-to-Implant | 2893 | 823 (28.45) | 0.60 ± 0.94 | 944 | 228 (24.15) | 0.44 ± 0.77 | 1.47 (1.27–1.71) | 1.66 (1.49–1.86) |
Two-Stage Reconstruction | ||||||||
Expander–Flap | 1004 | 439 (43.73) | 0.20 ± 0.49 | 148 | 67 (45.27) | 0.15 ± 0.47 | 0.94 (0.72–1.23) | 0.85 (0.69–11.04) |
Expander–Implant | 11,002 | 3130 (28.45) | 0.10 ± 0.40 | 2214 | 590 (26.65) | 0.07 ± 0.32 | 1.12 (1.02–1.23) | 1.02 (0.99–1.17) |
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Royse, K.E.; Smith, T.M.; Tan, C.M.; Lin, E.Y.; Neumann, R.G.; Harris, J.E.; Paxton, E.W.; Tong, W.M. Assessing First and Multiple Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Reconstructions in Women with Breast Cancer. Onco 2025, 5, 15. https://doi.org/10.3390/onco5020015
Royse KE, Smith TM, Tan CM, Lin EY, Neumann RG, Harris JE, Paxton EW, Tong WM. Assessing First and Multiple Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Reconstructions in Women with Breast Cancer. Onco. 2025; 5(2):15. https://doi.org/10.3390/onco5020015
Chicago/Turabian StyleRoyse, Kathryn E., Tina M. Smith, Cissy M. Tan, Eric Y. Lin, Robert G. Neumann, Jessica E. Harris, Elizabeth W. Paxton, and Winnie M. Tong. 2025. "Assessing First and Multiple Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Reconstructions in Women with Breast Cancer" Onco 5, no. 2: 15. https://doi.org/10.3390/onco5020015
APA StyleRoyse, K. E., Smith, T. M., Tan, C. M., Lin, E. Y., Neumann, R. G., Harris, J. E., Paxton, E. W., & Tong, W. M. (2025). Assessing First and Multiple Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Reconstructions in Women with Breast Cancer. Onco, 5(2), 15. https://doi.org/10.3390/onco5020015