Outcome and Impact on Adjuvant Treatment Processing Time after Mastectomy with or without Immediate Breast Reconstruction on a Large Cohort and Determination of a Postoperative Complications Predictive Score

Author(s): Léa Morante, Sandrine Rua, Monique Cohen, Laura Sabiani, Marc Martino, Max Buttarelli, Aurore Van Troy, Anthony Gonçalves, Agnès Tallet, Aurélie Jalaguier Coudray, Marie Bannier, Gilles Houvenaeghel

Background: Mastectomies are indicated in 12 to 40% of patients with an increase of immediate breast reconstruction (IBR) rate during the last years and complication rates between 5% to 61%. We analyzed data collected from 2016 to 2020 to assess the rate of IBR and complications, interval-time to adjuvant therapy and to establish a predictive score of postoperative complications.

Methods: We included all mastectomies performed from January 2016 to July 2020, in a retrospective analysis with prospective data collection of age, body mass index (BMI), ASA-status, diabetes, tobacco use, adjuvant treatments, year of treatment, type of mastectomy, modalities of IBR, complications and postoperative hospitalization length (POHL). We calculated a predictive score for complications.

Results: Among 2,112 mastectomies, IBR rate was 40.5%. Complication rate was 31.9% without difference between IBR and no-IBR groups. Grade 2-3 complications were significantly more frequent only for a BMI >30 (OR=1.8, p=0.002). Implant loss rate was 7.2% (44/609). A predictive score was determined with a significant increase of complications and Grade 2-3 breast complications rates (p<0.0001). The median POHL was 1 and 2 days in no-IBR and IBR groups. Intervaltime >60-days was associated only with age >75 years for adjuvant chemotherapy and age >75 years, Grade 2-3 complications and IBR for post-mastectomy radiotherapy.

Conclusions: Performing IBR was not significantly associated with complications and higher rate of interval-time >60-days for adjuvant chemotherapy. The complication predictive score can be a tool to inform patients at risks of complications and to compare results with others studies and techniques.