Investigation of the applicability of the BRA score tool in prosthetic breast reconstruction and definition of a risk rate cut-off

A. De Grazia, V. Cazzato, S. Bottosso et al

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The 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 gives back, for each patients, the risk of surgical complications in every type of breast reconstruction technique. The purpose of this study was to evaluate the effectiveness of using the calculator in patients who underwent prosthetic breast reconstruction with a submuscular tissue expander or prepectoral prosthesis.


Our retrospective study analyzed 92 patients whose data were 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 was assessed using statistical analysis.

In the two-stage subpectoral reconstruction group the Mann-Whitney U test showed a statistically significant difference in the 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 we found a cut-off of overall surgical complications rate 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 complications.

Our results suggest that the BRA score can accurately identify patients at risk for complications following two-stage subpectoral breast reconstruction. Moreover, we believe it’s possible to indentify a risk rate cut-off of overall surgical complications that potentially help physicians to find out the safest surgical strategy.

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