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Updated: Sep 19, 2025

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Comparing 90-Day Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Direct-to-Implant or

Kathryn E Royse1, Tina M Smith2, Cissy M Tan3

  • 1From the Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA.

Annals of Plastic Surgery
|June 18, 2025
PubMed
Summary

Immediate breast reconstruction shows higher reoperation risks than delayed, particularly with expanders or direct-to-implant methods. Autologous reconstruction timing did not significantly impact reoperation rates.

Keywords:
breast reconstructioncohort studydelayed breast reconstructionimmediate breast reconstructionreoperationreturn to care

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Area of Science:

  • Plastic Surgery
  • Oncology
  • Surgical Outcomes

Background:

  • Breast reconstruction after mastectomy is increasingly common.
  • This study evaluates short-term reoperation risks associated with reconstruction timing.
  • Subtypes of direct-to-implant and autologous reconstructions were analyzed.

Purpose of the Study:

  • To compare short-term unplanned return to the operating room (OR) for immediate breast reconstruction (IBR) versus delayed reconstruction.
  • To analyze reoperation rates based on specific reconstructive techniques.

Main Methods:

  • Retrospective analysis of 23,272 breast reconstructions from 2010-2022.
  • Comparison of 90-day reoperation rates between immediate and delayed reconstruction timing.
  • Logistic regression models adjusted for patient and surgical factors.

Main Results:

  • Immediate breast reconstruction (IBR) had significantly higher odds of reoperation (OR=1.96) compared to delayed reconstruction.
  • Reconstruction using tissue expanders showed increased reoperation odds with IBR (OR=1.83).
  • Immediate direct-to-implant reconstruction had the highest reoperation odds (OR=5.55); autologous reconstruction timing showed no significant difference.

Conclusions:

  • Immediate breast reconstruction, especially with expanders or direct-to-implant techniques, is associated with higher 90-day reoperation risks.
  • Delayed reconstruction may offer a safer short-term profile for certain techniques.
  • Autologous reconstruction timing does not appear to significantly influence short-term reoperation rates.