Women who choose to have breast reconstruction after mastectomy often have several choices available to them.

Now, researchers from the Michigan Breast Reconstruction Outcome Study have given women and their doctors some guidance regarding the risks. Based on a study of more than 300 women, they found that the type of procedure did not affect the complication rate.

Having reconstruction done at the same time as mastectomy — as opposed to later on — may be linked to a higher complication rate. But this may not mean that having a delayed reconstruction is safer, the authors cautioned.

Amy K. Alderman, MD, MPH, and colleagues reported their findings in the journal Plastic and Reconstructive Surgery (Vol. 109: 2265-2274).

Following a mastectomy, women who decide to have breast reconstruction usually have several options to choose from.

Many decide to have a saline implant placed in the breast area under the skin. Others opt for a TRAM (transverse rectus abdominis muscle) flap procedure. This involves taking extra tissue and muscle from the abdominal wall and moving it into the breast area.

This procedure may be done either as a free TRAM flap (where the tissue is removed from the abdomen and reattached in the breast area) or a pedicle TRAM flap (where the tissue is tunneled under the skin to the breast area).

Other options, such as the latissimus dorsi (a muscle in the upper back) flap procedure, are also used in some cases. While doctors and patients may have individual preferences, there is little good data on which procedure might be better or safer.

The timing of the procedure is also the subject of debate. In the past, doctors, and their patients, often preferred to delay the reconstruction. This allowed women time to adjust to the mastectomy, and may have given them a greater appreciation for the reconstruction.

But, having the reconstruction done at the same time as the mastectomy has become more popular in recent years. One advantage is that it may require only one trip to the operating room.

Alderman's team followed 326 women who had had one of three breast reconstruction procedures (implant, free TRAM flap, or pedicle TRAM flap) at one of 12 medical centers. Two years after reconstruction, they collected data on the problems the women experienced, using phone interviews and medical records.

The researchers defined "complications" as events resulting from the surgery that required additional treatment of some kind — such as antibiotics for an infection.

"Major complications" were events that required hospitalization, further surgery, or strong antibiotics.

About 45% of the women had at least one complication after the procedure, and about 32% had at least one major complication.

The high rates were unexpected, the researchers said.

The complication rate did not seem to depend on the type of procedure used. The researchers were also surprised to find that it was not affected by patient age, smoking status, or whether or not the women had had chemotherapy or radiation therapy.

But women who had immediate reconstruction were more than twice as likely to have complications as were those who delayed it. These women were also more than twice as likely to have major complications. The only other factor linked with more complications was higher body weight.

The authors cautioned against reading into the numbers as if delayed reconstruction was safer. The rates for immediate construction, they noted, were likely higher because they included complications due to the mastectomy as well. This was not the case with delayed reconstruction.

When the complication rates seen with mastectomy were added to those of delayed reconstruction, the rates were about the same as those seen for immediate reconstruction.

"Thus, the current study's finding should not be viewed as a basis for advocating delayed reconstructions," they said. "Rather, these results should be used to realistically inform patients, providers, and payers about the risks of reconstructive procedures."