Online Breast Reconstruction Risk Assessment (BRA) Score Tool in Prosthetic Breast Reconstruction in a Case Series with Cutoff Determination

Abstract

AbstractThe Breast Reconstruction Risk Assessment (BRA) score is a tool for the prediction of the risk of complications in breast surgery, elaborated in 2014. This score assesses the risk of surgical complications related to each type of breast reconstruction technique. The purpose of this study was to evaluate the effectiveness of using the calculator on patients who underwent prosthetic breast reconstruction with submuscular tissue expander or prepectoral prosthesis. Our retrospective study analyzed 92 patients whose data was entered into the calculator. The predicted and observed 1-year rates of overall surgical complications were compared, separately for both cohorts. Subsequently, the accuracy, the applicability, and the discrimination ability of the BRA score were assessed using statistical analysis. In the two-stage subpectoral reconstruction group, Mann–Whitney U test showed a statistically significant difference in BRA-score values between the patients who developed complications compared to the patients who had no complications (p-value < 0.02). Moreover, the score has an excellent discrimination ability (AUC = 0.9), and a cutoff of overall surgical complication rate was found to be between 17 and 18%. For the one-stage prepectoral prosthetic reconstruction group, the BRA score tool was unable to discriminate between patients with complications and patients without complication. Our results suggest that the BRA score can accurately identify patients with risk of complications following two-stage subpectoral breast reconstruction. Moreover, we believe it is possible to identify a risk rate cutoff of overall surgical complications that may potentially help physicians select the safest surgical strategy.