Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients
BACKGROUND:Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepecto...
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| Veröffentlicht in: | Plastic and reconstructive surgery (1963) 2020-06, Vol.145 (6), p.1357-1365 |
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| container_title | Plastic and reconstructive surgery (1963) |
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| creator | Gabriel, Allen Sigalove, Steven Storm-Dickerson, Toni L. Sigalove, Noemi M. Pope, Nicole Rice, Jami Maxwell, G. Patrick |
| description | BACKGROUND:Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepectoral and dual-plane reconstruction in high-BMI patients to determine whether there was an association between postoperative complications and the plane of reconstruction.
METHODS:High-BMI patients who underwent immediate dual-plane or prepectoral expander/implant reconstruction were included in this retrospective study. Patients were stratified by reconstructive approach (dual-plane or prepectoral), and postoperative complications were compared between the groups. Multivariate logistic regression analysis was performed to determine whether the plane of reconstruction was an independent predictor of any complication after adjusting for potential confounding differences in patient variables between the groups.
RESULTS:Of 133 patients, 65 (128 breasts) underwent dual-plane and 68 (129 breasts) underwent prepectoral reconstruction. Rates of seroma (13.3 percent versus 3.1 percent), surgical-site infection (9.4 percent versus 2.3 percent), capsular contracture (7.0 percent versus 0.8 percent), and any complication (25.8 percent versus 14.7 percent) were significantly higher in patients who had dual-plane versus prepectoral reconstruction (p < 0.05). Multivariate logistic regression identified dual-plane, diabetes, neoadjuvant radiotherapy, and adjuvant chemotherapy as significant, independent predictors of any complication (p < 0.05). Dual-plane reconstruction increased the odds of any complication by 3-fold compared with the prepectoral plane.
CONCLUSION:Compared with the dual-plane approach, the prepectoral approach appears to be associated with a lower risk of postoperative complications following immediate expander/implant breast reconstruction and may be a better reconstructive option in high-BMI patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III. |
| doi_str_mv | 10.1097/PRS.0000000000006840 |
| format | Article |
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METHODS:High-BMI patients who underwent immediate dual-plane or prepectoral expander/implant reconstruction were included in this retrospective study. Patients were stratified by reconstructive approach (dual-plane or prepectoral), and postoperative complications were compared between the groups. Multivariate logistic regression analysis was performed to determine whether the plane of reconstruction was an independent predictor of any complication after adjusting for potential confounding differences in patient variables between the groups.
RESULTS:Of 133 patients, 65 (128 breasts) underwent dual-plane and 68 (129 breasts) underwent prepectoral reconstruction. Rates of seroma (13.3 percent versus 3.1 percent), surgical-site infection (9.4 percent versus 2.3 percent), capsular contracture (7.0 percent versus 0.8 percent), and any complication (25.8 percent versus 14.7 percent) were significantly higher in patients who had dual-plane versus prepectoral reconstruction (p < 0.05). Multivariate logistic regression identified dual-plane, diabetes, neoadjuvant radiotherapy, and adjuvant chemotherapy as significant, independent predictors of any complication (p < 0.05). Dual-plane reconstruction increased the odds of any complication by 3-fold compared with the prepectoral plane.
CONCLUSION:Compared with the dual-plane approach, the prepectoral approach appears to be associated with a lower risk of postoperative complications following immediate expander/implant breast reconstruction and may be a better reconstructive option in high-BMI patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.</description><identifier>ISSN: 0032-1052</identifier><identifier>EISSN: 1529-4242</identifier><identifier>DOI: 10.1097/PRS.0000000000006840</identifier><identifier>PMID: 32195862</identifier><language>eng</language><publisher>United States: by the American Society of Plastic Surgeons</publisher><subject>Adult ; Aged ; Body Mass Index ; Breast - drug effects ; Breast - radiation effects ; Breast - surgery ; Breast Implants - adverse effects ; Breast Neoplasms - therapy ; Chemotherapy, Adjuvant - adverse effects ; Esthetics ; Female ; Humans ; Mammaplasty - adverse effects ; Mammaplasty - instrumentation ; Mammaplasty - methods ; Mastectomy - adverse effects ; Middle Aged ; Neoadjuvant Therapy - adverse effects ; Neoadjuvant Therapy - methods ; Patient Selection ; Pectoralis Muscles - transplantation ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Radiotherapy, Adjuvant - adverse effects ; Retrospective Studies ; Risk Factors ; Tissue Expansion Devices - adverse effects</subject><ispartof>Plastic and reconstructive surgery (1963), 2020-06, Vol.145 (6), p.1357-1365</ispartof><rights>by the American Society of Plastic Surgeons</rights><rights>2020American Society of Plastic Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4010-cf5de2aea8b89f70754878cf070354f67d6f2599a96a73d5ad478323c8c6d0e93</citedby><cites>FETCH-LOGICAL-c4010-cf5de2aea8b89f70754878cf070354f67d6f2599a96a73d5ad478323c8c6d0e93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32195862$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gabriel, Allen</creatorcontrib><creatorcontrib>Sigalove, Steven</creatorcontrib><creatorcontrib>Storm-Dickerson, Toni L.</creatorcontrib><creatorcontrib>Sigalove, Noemi M.</creatorcontrib><creatorcontrib>Pope, Nicole</creatorcontrib><creatorcontrib>Rice, Jami</creatorcontrib><creatorcontrib>Maxwell, G. Patrick</creatorcontrib><title>Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients</title><title>Plastic and reconstructive surgery (1963)</title><addtitle>Plast Reconstr Surg</addtitle><description>BACKGROUND:Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepectoral and dual-plane reconstruction in high-BMI patients to determine whether there was an association between postoperative complications and the plane of reconstruction.
METHODS:High-BMI patients who underwent immediate dual-plane or prepectoral expander/implant reconstruction were included in this retrospective study. Patients were stratified by reconstructive approach (dual-plane or prepectoral), and postoperative complications were compared between the groups. Multivariate logistic regression analysis was performed to determine whether the plane of reconstruction was an independent predictor of any complication after adjusting for potential confounding differences in patient variables between the groups.
RESULTS:Of 133 patients, 65 (128 breasts) underwent dual-plane and 68 (129 breasts) underwent prepectoral reconstruction. Rates of seroma (13.3 percent versus 3.1 percent), surgical-site infection (9.4 percent versus 2.3 percent), capsular contracture (7.0 percent versus 0.8 percent), and any complication (25.8 percent versus 14.7 percent) were significantly higher in patients who had dual-plane versus prepectoral reconstruction (p < 0.05). Multivariate logistic regression identified dual-plane, diabetes, neoadjuvant radiotherapy, and adjuvant chemotherapy as significant, independent predictors of any complication (p < 0.05). Dual-plane reconstruction increased the odds of any complication by 3-fold compared with the prepectoral plane.
CONCLUSION:Compared with the dual-plane approach, the prepectoral approach appears to be associated with a lower risk of postoperative complications following immediate expander/implant breast reconstruction and may be a better reconstructive option in high-BMI patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.</description><subject>Adult</subject><subject>Aged</subject><subject>Body Mass Index</subject><subject>Breast - drug effects</subject><subject>Breast - radiation effects</subject><subject>Breast - surgery</subject><subject>Breast Implants - adverse effects</subject><subject>Breast Neoplasms - therapy</subject><subject>Chemotherapy, Adjuvant - adverse effects</subject><subject>Esthetics</subject><subject>Female</subject><subject>Humans</subject><subject>Mammaplasty - adverse effects</subject><subject>Mammaplasty - instrumentation</subject><subject>Mammaplasty - methods</subject><subject>Mastectomy - adverse effects</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy - adverse effects</subject><subject>Neoadjuvant Therapy - methods</subject><subject>Patient Selection</subject><subject>Pectoralis Muscles - transplantation</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Radiotherapy, Adjuvant - adverse effects</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Tissue Expansion Devices - adverse effects</subject><issn>0032-1052</issn><issn>1529-4242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkElOwzAUhi0EoqVwA4R8AZcXD7GzpGVopSKqMmwj13FoIE0qO6F0xx24ISchpYAQC3ibN-j_3uJD6DCAbgCRPB5Prrvwo0LFYQu1A0Ejwimn26gNwCgJQNAW2vP-ASCQLBS7qMVoEAkV0ja6O611Tsa5Lix-ss7XHo-dXVhTlU7nuOes9hWeWFMWvnK1qbKywFmBB9n97O3ltVcmK3ypvcfDIrHPeKyrzBaV30c7qc69PfjsHXR7fnbTH5DR1cWwfzIihkMAxKQisVRbraYqSiVIwZVUJgUJTPA0lEmYUhFFOgq1ZInQCZeKUWaUCROwEesgvvlrXOm9s2m8cNlcu1UcQLzWFDea4t-aGuxogy3q6dwm39CXlyagNoFlmVeNlse8XloXz6zOq9l_v_kf6EdMME4o0GZqNrI-cfYOzTSEtQ</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Gabriel, Allen</creator><creator>Sigalove, Steven</creator><creator>Storm-Dickerson, Toni L.</creator><creator>Sigalove, Noemi M.</creator><creator>Pope, Nicole</creator><creator>Rice, Jami</creator><creator>Maxwell, G. Patrick</creator><general>by the American Society of Plastic Surgeons</general><general>American Society of Plastic Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20200601</creationdate><title>Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients</title><author>Gabriel, Allen ; Sigalove, Steven ; Storm-Dickerson, Toni L. ; Sigalove, Noemi M. ; Pope, Nicole ; Rice, Jami ; Maxwell, G. Patrick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4010-cf5de2aea8b89f70754878cf070354f67d6f2599a96a73d5ad478323c8c6d0e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Body Mass Index</topic><topic>Breast - drug effects</topic><topic>Breast - radiation effects</topic><topic>Breast - surgery</topic><topic>Breast Implants - adverse effects</topic><topic>Breast Neoplasms - therapy</topic><topic>Chemotherapy, Adjuvant - adverse effects</topic><topic>Esthetics</topic><topic>Female</topic><topic>Humans</topic><topic>Mammaplasty - adverse effects</topic><topic>Mammaplasty - instrumentation</topic><topic>Mammaplasty - methods</topic><topic>Mastectomy - adverse effects</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy - adverse effects</topic><topic>Neoadjuvant Therapy - methods</topic><topic>Patient Selection</topic><topic>Pectoralis Muscles - transplantation</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Radiotherapy, Adjuvant - adverse effects</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Tissue Expansion Devices - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gabriel, Allen</creatorcontrib><creatorcontrib>Sigalove, Steven</creatorcontrib><creatorcontrib>Storm-Dickerson, Toni L.</creatorcontrib><creatorcontrib>Sigalove, Noemi M.</creatorcontrib><creatorcontrib>Pope, Nicole</creatorcontrib><creatorcontrib>Rice, Jami</creatorcontrib><creatorcontrib>Maxwell, G. Patrick</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Plastic and reconstructive surgery (1963)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gabriel, Allen</au><au>Sigalove, Steven</au><au>Storm-Dickerson, Toni L.</au><au>Sigalove, Noemi M.</au><au>Pope, Nicole</au><au>Rice, Jami</au><au>Maxwell, G. Patrick</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients</atitle><jtitle>Plastic and reconstructive surgery (1963)</jtitle><addtitle>Plast Reconstr Surg</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>145</volume><issue>6</issue><spage>1357</spage><epage>1365</epage><pages>1357-1365</pages><issn>0032-1052</issn><eissn>1529-4242</eissn><abstract>BACKGROUND:Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepectoral and dual-plane reconstruction in high-BMI patients to determine whether there was an association between postoperative complications and the plane of reconstruction.
METHODS:High-BMI patients who underwent immediate dual-plane or prepectoral expander/implant reconstruction were included in this retrospective study. Patients were stratified by reconstructive approach (dual-plane or prepectoral), and postoperative complications were compared between the groups. Multivariate logistic regression analysis was performed to determine whether the plane of reconstruction was an independent predictor of any complication after adjusting for potential confounding differences in patient variables between the groups.
RESULTS:Of 133 patients, 65 (128 breasts) underwent dual-plane and 68 (129 breasts) underwent prepectoral reconstruction. Rates of seroma (13.3 percent versus 3.1 percent), surgical-site infection (9.4 percent versus 2.3 percent), capsular contracture (7.0 percent versus 0.8 percent), and any complication (25.8 percent versus 14.7 percent) were significantly higher in patients who had dual-plane versus prepectoral reconstruction (p < 0.05). Multivariate logistic regression identified dual-plane, diabetes, neoadjuvant radiotherapy, and adjuvant chemotherapy as significant, independent predictors of any complication (p < 0.05). Dual-plane reconstruction increased the odds of any complication by 3-fold compared with the prepectoral plane.
CONCLUSION:Compared with the dual-plane approach, the prepectoral approach appears to be associated with a lower risk of postoperative complications following immediate expander/implant breast reconstruction and may be a better reconstructive option in high-BMI patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.</abstract><cop>United States</cop><pub>by the American Society of Plastic Surgeons</pub><pmid>32195862</pmid><doi>10.1097/PRS.0000000000006840</doi><tpages>9</tpages></addata></record> |
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| identifier | ISSN: 0032-1052 |
| ispartof | Plastic and reconstructive surgery (1963), 2020-06, Vol.145 (6), p.1357-1365 |
| issn | 0032-1052 1529-4242 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Aged Body Mass Index Breast - drug effects Breast - radiation effects Breast - surgery Breast Implants - adverse effects Breast Neoplasms - therapy Chemotherapy, Adjuvant - adverse effects Esthetics Female Humans Mammaplasty - adverse effects Mammaplasty - instrumentation Mammaplasty - methods Mastectomy - adverse effects Middle Aged Neoadjuvant Therapy - adverse effects Neoadjuvant Therapy - methods Patient Selection Pectoralis Muscles - transplantation Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - prevention & control Radiotherapy, Adjuvant - adverse effects Retrospective Studies Risk Factors Tissue Expansion Devices - adverse effects |
| title | Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients |
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