A proposal for a new classification of complications in reconstructive and aesthetic breast surgery: the HIBA classification.

Background
Breast surgery lacks a standardized classification of postoperative complications. This leads to the presentation of varying rates of postoperative complications and makes comparisons between studies difficult, hinders the final evaluation of the costs of this type of procedure and prevents reliable presentation of preoperative information to patients who consult for this type of procedure. The aim of this study is to apply a new complication classification developed by the authors to breast surgery.
Methods
We retrospectively evaluated 236 patients undergoing breast surgery with a follow-up of at least 6 months. Our classification of surgical complications consists of four grades of severity based on the complexity of the intervention required for treatment, the setting in which the patient is treated and the medical costs of treatment. Grade A includes complications that are treated in the outpatient setting. Grade B includes those that require the patient to return to the operating room or be hospitalized. Grade C corresponds to life-threatening complications requiring intensive care. Finally, grade D corresponds to the death of the patient. Each degree of severity is broken down according to the aforementioned criteria. The overall complication rate was calculated and complications were classified according to the proposed classification.
Results
A total of 236 patients undergoing breast surgery and with a follow-up of at least 6 months were included. The mean age was 47.6 years and 87.2% of the patients were female. One hundred and thirty-seven (58.1%) were reconstructive surgeries, while ninety-nine (41.9%) were cosmetic. Among the immediate reconstructive surgeries, six were autologous reconstructions (4.9%) and one hundred and sixteen were implant-based reconstructions (95.1%). Mastopexy with or without implant replacement or removal was the most performed procedure among cosmetic surgeries (24, 24.2%), followed by reduction mastoplasty (19, 19.1%). One hundred and thirty-eight (58.4%) procedures were inpatient. A total of one hundred and sixty-four complications were recorded in one hundred and fifteen (48.7%) patients. Of these, one hundred thirty-six (82.9%) were mild complications that were treated in the outpatient setting. Twenty-three (13.8%) of these complications did not require any additional intervention beyond those expected for the type of surgery (grade A1). On the other hand, 100 (60.9%) complications of the same degree of severity required some type of additional behavior or follow-up in the outpatient setting, and were classified as A2. Among the latter, the most frequent complication was stitch extrusion (24, 17.6%), which required an additional visit to the office for removal. Ten (6.0%) patients had to be reoperated with local anesthesia or under ultrasound or radiological guidance to resolve some complication, the most frequent cause within this group (grade B1) was seroma (3, 2.2%). Six (3.6%) patients had to be reoperated under general anesthesia (grade B3), the most common causes were capsular contracture (2, 1.4%) and implant exposure (2, 1.4%). There were no life-threatening complications or deaths within our cohort. Most complications occurred in the first postoperative month (99, 60.3%) and were grade A2 (67, 49.2).
Conclusions
The application of this classification system for surgical complications in breast surgery provides a valuable tool for standardized assessment, reporting of postoperative outcomes and evaluation of quality of care in the short, medium and long term. The number of complications recorded with this classification exceeds that of traditional classifications such as Dindo-Clavien, which are foreign to our specialty, because our classification includes events such as pathological scarring and stitch extrusion, which prolong medical care times, require some type of additional treatment and have an impact on patient satisfaction. At the same time, this system allows surgeons to identify areas for improvement in surgical techniques and patient care protocols. Further investigation and validation of the classification system is warranted to optimize its utility in clinical practice and improve patient safety in plastic surgery procedures.

Breast

PSTM 2024