Breast reconstruction after mastectomy: one surgery is rarely enough

NEW YORK - Most women who have breast reconstruction after mastectomy will need a second and sometimes a third operation, according to a study from Canada.

Among a cohort of 3,972 women who had post-mastectomy breast reconstruction, 3,504 (88%) underwent at least one re-operation during an average follow up of about five years. The first re-operation occurred on average within seven months of the primary reconstruction.

Two-thirds (65%) of the cohort had more than one re-operation; 39% needed three or more re-operations. The median number of procedures per patient was two.

Dr. Amanda Roberts, of University of Toronto reported the findings April 30 at the annual meeting of the American Society of Breast Surgeons in Orlando, Florida.

"Women undergoing post-mastectomy breast reconstruction should expect to have an average of two re-operations following their primary reconstruction," Dr. Roberts said during a media briefing.

Forty-two percent of re-operations were anticipated, while 37% were not, she noted. The remainder were minor skin or scar-related procedures or cancer-related surgeries.

Anticipated re-operations included nipple reconstruction, replacement of tissue expanders with implants and rebalancing of the opposite breast for enhanced cosmesis. Unanticipated re-operations were typically for acute, sub-acute or long-term complications of the primary surgery, revisions related to undesirable implant placement or complications such as infection.

"Our results provide the first long-term population-level data on the current state of post-mastectomy breast reconstruction re-operation rates," the authors note in a meeting abstract.

"Women undergoing mastectomy and reconstruction must be aware that even after their cancer surgery is complete, their journey through the medical system and the after effects of this disease are ongoing," Dr. Roberts said in a news release.

"This study helps build quantitative expectations of the typical path that follows reconstruction and promotes more informed patient-physician decisions on treatment options. Excessive additional surgeries can lead to other medical concerns and increased healthcare costs," she added.

SOURCE: The American Society of Breast Surgeons 16th Annual Meeting, 2015.

References: Reuters Health
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