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The complication rates following surgery of the breast and axilla are considered low. The mortality after these procedures is less than 1%; most complications are wound related (ie, surgical site infections and seroma). These complications may lead to cosmetic compromise and psychological distress to the patient; result in increased costs, prolonged hospital stays, and frequent outpatient visits; and potentially delay important adjuvant therapies. In this chapter, the following topics are addressed:

  • Early systemic complications (ie, cardiovascular complications, thromboembolic events, and allergic reactions)
  • Early wound-related complications, including hematomas, wound infections, and seromas
  • Long-term complications such as chronic breast cellulitis, lymphedema, and chronic pain
  • Future directions for scientific study

In a prospective review of 3107 patients using National Surgical Quality Improvement Program (NSQIP) data, El-Tamer et al reported a 30-day mortality rate of 0.128% after surgery for breast cancer. The mortality rate was significantly increased in patients after mastectomy when compared with lumpectomy (0.24% vs 0.0%), but death remained a rare postoperative event. Breast cancer operations are commonly performed on an elective basis, enabling thorough preoperative evaluation and potential optimization of patients deemed to be high risk. In addition, patients with breast cancer are relatively healthy overall, as most (>85%) patients are classified as ASA 1 or 2.1

Furthermore, breast and axillary procedures are classified as clean, soft tissue operations, with no violation of the thoracic or abdominal cavity. As a result, serious infections are rare. As most patients are considered low risk, the incidence of cardiac complications after breast surgery is also low; the incidence of cardiovascular complications is 0.06% in mastectomy patients. The incidence of stroke is 0.1%. Pulmonary complications are also rare, even with the use of general anesthesia.1

Thromboembolic Events

It is well established that patients with a diagnosis of cancer are at an increased risk of thrombotic events. The estimated annual incidence of thrombotic events in the general population is 0.117%; cancer patients have a 4-fold increase in risk.2 The pathogenesis of the hypercoagulable state in cancer is multifactorial: activation of the coagulation and fibrinolytic cascades, change in the vascular endothelium, generation of acute phase reactants, and hemodynamic compromise.3

Patients undergoing surgery for breast cancer often exhibit multiple factors that put them at increased risk of thrombotic events: advanced age, diagnosis of malignancy, use of previous chemotherapy or hormonal therapy, and indwelling central venous catheters.4 The risk of thrombosis is patients with breast cancer is somewhat lower when compared with other malignancies (brain, pancreas, primary liver). The MD Anderson Cancer Center reported their results in a series of 3898 patients who underwent 4416 breast surgical procedures. Seven women developed venous thrombosis within 60 days of surgery, for a rate of 0.16% per procedure.2

There is little consensus regarding the optimal strategy for thromboembolic prophylaxis in the breast cancer population. Randomized trials in the general surgical, orthopedic, ...

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