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J Reconstr Microsurg
DOI: 10.1055/a-2491-3110
Original Article

Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer

Gabriel De La Cruz Ku
1   Universidad Cientifica del Sur, Lima, Peru
2   Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
,
Anshumi Desai
3   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Medical School, Miami, Florida
,
Meera Singhal
4   Department of Surgery, Tufts Medical Center, Boston, Massachusetts
,
Michael Mallouh
1   Universidad Cientifica del Sur, Lima, Peru
,
Caroline King
4   Department of Surgery, Tufts Medical Center, Boston, Massachusetts
,
Alexis N. Rojas
3   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Medical School, Miami, Florida
,
Sarah Persing
5   Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
,
Christopher Homsy
5   Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
,
Abhishek Chatterjee
5   Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
6   Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
,
Salvatore Nardello
6   Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
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Abstract

Background Two common surgical approaches for breast cancer are breast-conserving surgery and mastectomy with implant-based breast reconstruction (MIBR). However, for large tumors, an alternative to MIBR is oncoplastic surgery with volume replacement (OPSVR). We performed a comprehensive analysis comparing OPSVR with MIBR, with our aim to focus on the 30-day postoperative complications between these two techniques.

Methods We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2020. Only breast cancer patients were included and were divided according to the surgical technique: OPSVR and MIBR. Logistic regression analysis was used to assess independent risk factors for total, surgical, and wound complications.

Results A cohort of 8,403 breast cancer patients was analyzed. A total of 683 underwent OPSVR and 7,720 underwent MIBR. From 2005 to 2020, the adoption of OPSVR gradually increased over the years (p < 0.001), whereas MIBR decreased. OPSVR patients were older (57.04 vs. 51.89 years, p < 0.001), exhibited a higher body mass index (31.73 vs. 26.93, p < 0.001), had a greater prevalence of diabetes mellitus (11.0 vs. 5.0%, p < 0.001). They also had a higher ASA classification (2.33 vs. 2.15, p < 0.001), shorter operative time (173.39 vs. 216.20 minutes, p < 0.001), and a higher proportion of outpatient procedures (83.7 vs. 39.5%, p < 0.001). Outcome analysis demonstrated fewer total complications in the OPSVR patients (4.2 vs. 10.9%, p < 0.001), including lower rates of surgical complications (2.2 vs. 8.0%, p < 0.001) and wound complications (1.9 vs. 4.8%, p = 0.005) compared with MIBR patients. Multivariate analysis identified OPSVR as an independent protective factor for total, surgical, and wound complications.

Conclusion OPSVR has become a favorable technique for patients with breast cancer. Even in patients with higher comorbidities, OPSVR demonstrates safe and better outcomes when compared with MIBR. It should be considered a reasonable and safe breast surgical option in the appropriate patient.

Keywords

oncoplastic surgery - mastectomy implant-based reconstruction - outcomes - complications

Data Availability Statement

The data that support the findings of this study are available upon request at the American College of Surgeons National Surgical Quality Improvement Program.


Note

This work was presented at the 25th Annual Meeting of the American Society of Breast Surgeons, Orlando, FL, April 2024.


Supplementary Material



Publication History

Received: 21 July 2024

Accepted: 23 November 2024

Accepted Manuscript online:
28 November 2024

Article published online:
20 December 2024

© 2024. Thieme. All rights reserved.

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