Comparing 90-Day Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Direct-to-Implant or Autologous Reconstructions

Kathryn E Royse; Tina M Smith; Cissy M Tan; Eric Y Lin; Robert G Neumann; Jessica E Harris; Elizabeth W Paxton; Winnie Tong

doi:10.1097/SAP.0000000000004421

Comparing 90-Day Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Direct-to-Implant or Autologous Reconstructions

Ann Plast Surg. 2025 Jun 11. doi: 10.1097/SAP.0000000000004421. Online ahead of print.

Authors

Kathryn E Royse¹, Tina M Smith², Cissy M Tan³, Eric Y Lin⁴, Robert G Neumann⁴, Jessica E Harris¹, Elizabeth W Paxton¹, Winnie Tong⁵

Affiliations

¹ From the Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA.
² Department of Plastic Surgery, The Permanente Medical Group, Walnut Creek, CA.
³ Department of Plastic Surgery, Southern California Permanente Medical Group, San Diego, CA.
⁴ Department of Plastic Surgery, The Permanente Medical Group, Santa Rosa, CA.
⁵ Department of Plastic Surgery, The Permanente Medical Group, San Francisco, CA.

PMID: 40532244
DOI: 10.1097/SAP.0000000000004421

Abstract

Background: In recent years, breast reconstruction following mastectomy has gained popularity. This study aimed to compare short-term unplanned return to the operating room (OR) for women undergoing breast reconstruction after mastectomy for malignancy by reconstruction timing, delayed compared to immediate (IBR). Subcategories of direct-to-implant and primarily autologous reconstruction were analyzed.

Methods: Data from an integrated electronic medical record system identified patients undergoing breast reconstruction after mastectomy at Kaiser Permanente facilities between 2010-2022. Reconstruction timing was the exposure of interest, with stratification based on reconstructive techniques including tissue expander followed by either implant or autologous reconstruction, direct-to-implant, or primarily autologous reconstruction. Univariable and multivariable logistic regression models assessed the association between reconstruction timing and 90-day reoperations in direct-to-implant or primarily autologous reconstruction, using delayed reconstruction as the reference.

Results: A total of 23,272 cases were identified (immediate = 18,248, delayed = 5025). The IBR patients exhibited higher odds of reoperations [odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.65-2.33, P < 0.0001] compared to delayed reconstruction after covariate adjustment. Among patients with expanders, IBR increased reoperation odds (OR = 1.83, 95% CI = 1.43-2.33, P < 0.0001). Immediate direct-to-implant reconstruction had the highest reoperation odds (OR = 5.55, 95% CI = 2.08-4.67, P = 0.039). No significant differences were observed between immediate and delayed approaches in autologous reconstruction, regardless of whether it was conducted in a single- or 2-stage process.

Conclusions: Immediate reconstruction, involving expanders or direct-to-implant reconstructions, showed increased 90-day reoperation risks compared to delayed reconstruction. Conversely, no significant differences were identified between IBR and delayed reconstruction with autologous reconstruction conducted in a single- or 2-stage process.

Keywords: breast reconstruction; cohort study; delayed breast reconstruction; immediate breast reconstruction; reoperation; return to care.