Women who undergo mastectomy and immediate reconstruction with implants face an increased risk for implant failure and loss within the first 30 days post-surgery if they are obese or smoke, a new study has found.

The findings paint reconstructive surgery as a tenuous balance between patient and doctor responsibility, as the new information suggests a more critical evaluation of patient eligibility for doctors and may possibly compel women to adopt a different lifestyle in order to minimize their post-operative risks.

"The goal of our study was really to determine which patients are at greatest risk for experiencing significant complications with their implants in the first 30 days after breast reconstruction,” lead author Dr. John Fischer, a plastic surgery resident from the University of Pennsylvania, said in a statement, adding the hope for this reconstruction is “that it will allow practicing surgeons, including reconstructive surgeons, an opportunity to better tailor preoperative risk counseling and improve patient selection.”

Publishing in the Journal of the American College of Surgeons, a team of doctors from Penn and Yale University analyzed the post-surgery outcomes of 14,585 women between the ages of 40 and 60 who had undergone immediate breast reconstruction. The team isolated two variables — smoking and obesity — to build upon past studies that found recovery times tend to lengthen when patients smoke or are overweight. The team found both variables, in fact, confer a risk of implant failure three times greater than women who show neither trait.

What’s more, Fischer and his colleagues found obesity’s risk functions progressively. As opposed to a flat threshold, the team found "the more severe the state of obesity, the higher their risk of this complication,” as Fischer explained.

Mastectomy reconstruction happens in one of two ways. A women can either elect to use the existing tissue on her body to reconstruct one or both breasts (known as an autologous tissue-based procedure), if she’s eligible based on the tissue’s mass and health; or she can choose the less invasive route and gradually have expandable implants inserted into her chest, before the final surgeries where permanent implants are introduced. However, recently researchers have speculated that roughly seven out of every 10 mastectomies are unnecessary, presenting further evidence that the present study can aid doctors and patients alike in deciding whether lifestyle factors would present undue risk.

The upside is that smoking and obesity still present relatively low risks for implant failure post-surgery. Researchers were able to stratify the women into three groups depending on their risk level. "Less than one percent of all patients in our study experienced this complication occur, but when we stratified patients into low, intermediate, and high-risk groups, the risk went from .39 percent to 1.48 percent to 3.86 percent," Fischer explained. "It may seem like a small difference, but the difference is clinically significant because what it means is that one in 25 patients in the high-risk group will lose a device within 30 days."

Doctors can use this information, the team notes, to assess a patient’s potential “risk score,” based on a simple clinical tool they developed. Surgeons can weigh a woman’s risk of implant failure according to prescribed, weighted factors that look at her smoking habits and weight, and instantly judge her risk for complications. The more risk factors she has, the more likely she’ll be forced to have her implants removed within 30 days.

"If a patient learns she has a high risk for complications with breast implants, she may choose to have an autologous tissue based procedure. The risk might not be worth it, or, on the other hand, the patient accepts the risk. Either way, the expectations are better managed and overall satisfaction is likely to be higher," Fischer said. "Our main desire is to help improve the outcomes and care for breast reconstruction patients."

 

Source: Fischer J, Wes A, Tuggle C, Serletti J, Wu L. Risk Analysis of Early Implant Loss after Immediate Breast Reconstruction: A Review of 14,585 Patients. Journal of the American College of Surgeons. 2013.