Complications following subcutaneous mastectomy with Immediate Breast Reconstruction

Abstract

Background: Breast cancer is the most frequent cancer among Norwegian women, and one of the surgical treatments involves subcutaneous mastectomy with immediate breast reconstruction. A master thesis published in 2017 reported that 56% of the breasts that underwent this type of surgery at UNN Tromsø, developed one or more postoperative complications. Based on the complication rate and new research on the field, changes were made in the surgical technique. The purpose of this study is to investigate if changes made in the surgical technique at UNN Tromsø has led to a reduction in postoperative complications. The changes include implementation of vertical incision, hydrodissection and prepectoral breast reconstruction. Materials and method: The study was conducted as a retrospective observational study for quality assurance at the Department of Urology, Breast and Endocrine- and Plastic and Reconstructive Surgery at UNN Tromsø. All patients having undergone subcutaneous mastectomy with immediate reconstruction during 2017-2021 were included. Results: A total of 87 patients (138 breast) were included in the study. The postoperative complication rate was reduced from 56% in the previous thesis to 32% in this study. Breasts operated without the HD technique had a significantly higher rate of skin flap necrosis (p = 0.004). Vertical incision was the most frequent used incision and was used in 50% of the breasts. No significant difference in complication rates were found when comparing prepectoral and subpectoral reconstruction. Reoperation was needed in 42% of the breasts because of complications and 31% of the breast needed one or more additional surgeries to obtain a cosmetic favorable result. Conclusion: A reduction in postoperative complications was found after the changes were made in the surgical technique. Vertical incision was used most frequent, and breasts operated without the HD technique had a significantly higher rate of skin flap necrosis, indicating that HD and vertical incision may have had a contributing factor to the reduction.