Introduction:
There has been an increased emphasis on clinical outcomes to improve the quality of surgical care. Although mastectomy and lumpectomy procedures have a low risk for complications, breast reconstruction is widely assumed to have a higher rate of complications. The purpose of this study is to examine perioperative surgical site infections and wound complications across all three groups and identify risk factors that increase complications in breast reconstruction.
Methods:
A prospective, multi-institutional study of patients undergoing breast reconstruction, mastectomy, and lumpectomy was performed from the National Surgical Quality Improvement Program (NSQIP) from 2005 to 2007. Thirty day morbidity was prospectively collected with emphasis on superficial and deep surgical site infections as well as wound disruption. Univariate analysis was also performed examining body mass index (BMI) and complications in breast reconstruction.
Results:
We identified 27234 total patients who underwent breast reconstruction (n = 246), mastectomy (n = 10471), and lumpectomy (n = 16517). There were no statistically significant differences in any complications between breast reconstruction and mastectomy for superficial or deep surgical site infections, however, there was an increase in wound disruption (p = 0.013). When compared to lumpectomy, there was a significantly higher incidence of all three complications in breast reconstruction patients. When examining BMI and breast reconstruction, there was a significant increase in risk of superficial surgical site infections with a BMI > 25 (p = 0.018).
Conclusion:
Complications were uniformly low in lumpectomy, mastectomy, and breast reconstruction. Infectious complication rates were similar between breast reconstruction and mastectomy patients, however, wound disruption was higher after reconstruction. When examining risks for complications in breast reconstruction, overweight patients have a higher incidence of superficial surgical site infections. A proper understanding of the incidence of complications in breast reconstruction is necessary for proper counseling of patients.
Table 1: Incidence of Complications

	Breast Reconstruction	Mastectomy	p-value*	Lumpectomy	p-value^
Patients, n	246	10471		16517
Superficial surgical site infections	3.3% (8)	2.4% (255)	0.399	1.2% (200)	0.012
Deep surgical site infections	1.2% (3)	0.8% (80)	0.442	0.18% (29)	0.011
Wound disruption	1.6% (4)	0.34% (36)	0.013	0.11% (18)	<0.001

* 2x2 table comparing mastectomy to breast reconstruction
^ 2x2 table comparing lumpectomy to breast reconstruction
Chi-square and Fisher's exact test where appropriate