The significance of timing in breast reconstruction after mastectomy: An ACS-NSQIP analysis

Abstract

BackgroundA variety of breast reconstruction (BR) options are available. The significance of timing on outcomes remains debated. This study aimed to compare complications in breast cancer patients undergoing implant-based and autologous BR immediately after mastectomy or at a delayed time point. MethodsWe reviewed the ACS-NSQIP database (2008-2021) to identify all female patients who underwent BR for oncological purposes. Outcomes were stratified by technique (implant-based versus autologous) and timing (immediate versus delayed), and included 30-day mortality, reoperation, (unplanned) readmission, surgical and medical complications. Results21,560 patients were included: 11,237 (52%) implant-based (9,791/87% immediate, 1,446/13% delayed) and 10,323 (48%) autologous (8,378/81% immediate, 1,945/19% delayed). Complications occurred in 3,666 (17%) patients (Implant-based: 1,112/11% immediate, n=64/4.4% delayed cohorts; Autologous: n=2,073/25% immediate, n=417/21% delayed). In propensity score weighting analyses, immediate BR was associated with significantly more complications than delayed BR (p<0.0001). This was the case for both implant-based and autologous BR, with a greater difference between the two time points noted in implant-based. Confounder-adjusted multivariable analyses confirmed these results. ConclusionAt the 30-day time point, delayed BR is associated with significantly lower complication rates than immediate BR, in both the implant-based and autologous cohorts. These findings are not a blanket recommendation in favor of immediate and/or delayed BR. Instead, our insights may guide surgeons and patients in decision-making and help refine patients’ eligibility in a case-by-case workup.