Patients Who Refuse Blood Transfusions Should Not Be Discouraged from Immediate Direct-to-Implant Breast Reconstruction After Mastectomy: A Retrospective Study on Severe Bleeding Risks

Direct-to-implant breast reconstruction is the most common method for immediate breast restoration after mastectomies performed with prophylactic or curative indications. This approach significantly enhances patients' quality of life without adversely affecting oncological outcomes. However, it remains unclear whether mastectomy with direct-to-implant breast reconstruction (M-DTI) is an optimal option for patients who refuse blood transfusions for religious reasons (e.g., Jehovah's Witnesses) or other personal beliefs.

We retrospectively reviewed 490 patients who underwent either mastectomy alone (MA) or M-DTI between January 2021 and June 2023. We analyzed patient characteristics, operative details, and rates of bleeding complications.

MA was performed on 220 patients, while mastectomy with immediate breast reconstruction was conducted on 270 patients. Overall, bleeding complications-including those requiring reoperation and/or blood transfusion-occurred in 21 patients. In the MA group, bleeding complications occurred in 2.4% of patients, compared to 1.8% in the M-DTI group (p = 0.249). The risk of severe bleeding was unrelated to age, diagnosis, or type of procedure.

The findings of this study suggest that immediate breast reconstruction does not increase the risk of bleeding in patients undergoing mastectomy. Therefore, it should also be considered a viable option for patients requiring bloodless medicine.