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- Title:
The significance of timing in breast reconstruction after mastectomy: An ACS-NSQIP analysis.
- Document type:
- Review; Journal Article
- Author(s):
- Knoedler, Samuel; Kauke-Navarro, Martin; Knoedler, Leonard; Friedrich, Sarah; Ayyala, Haripriya S; Haug, Valentin; Didzun, Oliver; Hundeshagen, Gabriel; Bigdeli, Amir; Kneser, Ulrich; Machens, Hans-Guenther; Pomahac, Bohdan; Orgill, Dennis P; Broer, P Niclas; Panayi, Adriana C
- Abstract:
- BACKGROUND: A variety of breast reconstruction (BR) options are available. The significance of timing on outcomes remains debated. This study aims 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, and surgical and medical complications. RESULTS: A total of 21,560 patients were included: 11,237 (52%) implant-based (9791/87% immediate, 1446/13% delayed) and 10,323 (48%) autologous (8378/81% immediate, 1945/19% delayed). Complications occurred in 3666 (17%) patients (implant-based: n = 1112/11% immediate, n = 64/4.4% delayed cohorts; Autologous: n = 2073/25% immediate, n = 417/21% delayed cohorts). In propensity score weighting (PSW) 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.
- Journal title abbreviation:
- J Plast Reconstr Aesthet Surg
- Year:
- 2024
- Journal volume:
- 89
- Pages contribution:
- 40-50
- Fulltext / DOI:
- doi:10.1016/j.bjps.2023.11.049
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/38134626
- Print-ISSN:
- 1748-6815
- TUM Institution:
- Lehrstuhl für Plastische Chirurgie und Handchirurgie (Prof. Machens)
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