Thursday, October 28, 2010

Fiorina’s Infection Highlights Reconstruction Complications

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

The news report of California Republican U.S. Senate Candidate Carly Fiorina’s recent hospitalization due to an infection related to her breast reconstruction is an opportunity to talk about the risks of complication associated with breast reconstruction surgery.
Fiorina was diagnosed with breast cancer diagnosis in February 2009.  She was treated with chemotherapy, radiation and a double mastectomy.  I found several articles that note she had her reconstructive surgery at Stanford University Medical Center, the San Jose (Calif.) in July 2010, but none mention the reconstruction technique used.
My guess would be implant based reconstruction considering how quickly she returned to campaigning.  Recovery time for a TRAM flap (free or pedicle) or any other flap based reconstruction would have been much longer.
The chemotherapy and radiation put her at increased risk of surgical complications.  It’s all a balancing act.  Weighing the need/desire for reconstruction against the risks.  Treatment of the breast cancer is always the first priority.
As noted by in the eMedicine article (1st reference below)
The occurrence of complications using expander-implants can exceed 40% in published studies. However, despite a significant rate, the complications themselves are usually minor and do not prevent completion of a satisfactory reconstruction. In experienced hands, good to excellent aesthetic outcomes can be obtained in more than 80% of patients.
The 40% includes every little complication that can occur:  capsular contracture, infection, wound healing issues, seroma/hematoma, assymetry, poor implant position, etc.
Breaking it down better is the table found from the Mentor Large Simple Trial data that lists the complications that occur within 3 years.
Additional Operation (Reoperation) 40%
Loss of Nipple Sensation 35%
Capsular Contracture III/IV or grade unknown 30%
Asymmetry 28%
Implant Removal 27%
Wrinkling 20%
Breast Pain 17%
Infection 9%
Leakage/Deflation 9%
Irritation/Inflammation 8%
Delayed Wound Healing 6%
Seroma 6%
Scarring 5%
Extrusion 2%
Necrosis 2%
Hematoma 1%
Position Change 1%

What these numbers don’t do is individualize the risk.  You can’t tell from these numbers who had only radiation, who had only chemotherapy, who had both, which ones smoked, who had diabetes, etc.  All of these things increase the risk to the individual.

Related Post:
Patient Satisfaction Following Breast Reconstruction Using Implants (June 7, 2010)

Breast Reconstruction, Expander-Implant; eMedicine article, October 2009; Jorge I de la Torre, MD, FACS, Luis O Vasconez, MD, FACS
Breast Reconstruction Overview; eMedicineHealth
About Breast Reconstruction; Cancer Help UK


BrainDame said...

Great summary and reminder that no surgery is risk free

Sassenach said...

Good article.

I do wonder, though, how many good, talented people do not run for office because they do not wish to have the most intimate details of their health discussed and debated.

rlbates said...

Sassenach, I had this discussion with a friend just 2 days ago. I'm sure there are many.