Open Access

Samuel Knoedler, Martin Kauke-Navarro, Leonard Knoedler, Sarah Friedrich, Haripriya S. Ayyala, Valentin Haug, Oliver Didzun, Gabriel Hundeshagen, Amir Bigdeli, Ulrich Kneser, Hans-Guenther Machens, Bohdan Pomahac, Dennis P. Orgill, P. Niclas Broer, Adriana C. Panayi

• Background A 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. Methods We 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. Results 21,560 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). InBackground A 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. Methods We 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. Results 21,560 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. Conclusion At 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.…