Reconstructive Burnout after Mastectomy: Implications for Patient Selection

Background: The reconstructive journey after mastectomy can be a long road, with many hurdles to achieve an ideal aesthetic result. Cancer therapy, operative complications, and comorbidities impact patients physically and emotionally. This study introduces the term reconstructive burnout and aims to evaluate which factors predict and contribute to patients prematurely stopping reconstruction. Methods: The authors performed a retrospective review of patients undergoing breast reconstruction after skin-sparing mastectomy from 2014 to 2017 performed by two senior surgeons (N.T.H. and S.S.T.) at a single institution. Reconstructive burnout is defined as either no breast mound creation or completion of the breast mound without completion of all major revisions. Results: A total of 530 patients were included, with 76.6% completing reconstruction. In patients undergoing delayed-immediate reconstruction, patients with wounds (P = 0.004), infections (P = 0.037), or a complication requiring operative intervention (P < 0.001) were correlated with incomplete reconstruction; explantation of expanders was highly correlated with reconstructive burnout (P < 0.001). Implant-based and autologous reconstruction had comparable burnout rates (17.1% versus 19.1%; P = 0.58). Logistic regression models found high body mass index, radiation therapy, any tissue expander complication, and tissue expander explantation to be significant predictors of burnout. Autologous reconstruction was the strongest predictor of completion of reconstruction in both univariable and multivariable models. Conclusions: Reconstructive burnout in breast reconstruction is associated with tissue expander complications, high body mass indices, and radiation therapy. Overall rates of burnout were comparable between autologous and implant-based reconstruction, with autologous reconstruction being the strongest predictor of completion of reconstruction. It is critical to tailor each patient’s reconstructive journey to meet both their emotional and physical needs to avoid reconstructive burnout.