Complications in smokers after postmastectomy tissue expander/implant breast reconstruction

Smoking is universally considered to be a risk factor for surgical complications. The incidence of complications following tissue expander/implant breast reconstruction in patients who smoke has not been previously evaluated. A review of complications following tissue expander/irriplant reconstruction in 5 15 patients was performed. Patients who had 2-stage, tissue expander/implant reconstruction at Memorial Sloan-Kettering Cancer Center between May 2002 and December 2003 were included. Complications in smokers (n = 132) and nonsmokers (n = 383) were compared. The rate of overall complications, reconstructive failure, mastectomy flap necrosis, and infectious complications was significantly higher in smokers compared with nonsmokers. The rate of complications in ex-smokers was also higher than in nonsmokers. Using multivariate statistical analysis to adjust for confounding variables, smoking was identified as independent predictor of postoperative complications. A significant association between smoking status and postoperative complications exists. Thus, smokers who undergo postmastectomy expander/implant reconstruction should be informed of the increased risk of surgical complications and should be counseled on smoking cessation.