Rib Resection vs. Rib Preservation in Autologous Breast Reconstruction: An Outcome Analysis of 234 Patients

In autologous breast reconstruction, the internal mammary artery is the preferred recipient vessel. Although rib-resecting is usually performed, the rib-preserving technique has gained increasing attention in recent years without being scientifically evaluated.

In our retrospective study, we analyzed 234 autologous breast reconstructions performed between 2018 and 2023 at a single hospital, comparing 163 patients who underwent rib resection with 71 patients who received the rib-preserving technique. Intraoperative data, postoperative pain medication usage, and follow-up interventions over a minimum of one year were screened.

Ischemia time was significantly shorter in the rib-resecting group (45:00 min, IQR 37:44-60:00) compared with the rib-sparing group (50:59 min, IQR 43:59-71:00; p = 0.006). However, the rib-sparing group had longer pedicle lengths (11, IQR 10-12 vs. 10, IQR 9.5-11 cm; p = 0.074) and larger arterial diameters (p = 0.084). Postoperatively, rib-resecting patients required longer opioid treatment (3, IQR 2-4.25 vs. 2.5, IQR 1.63-3 days; p = 0.019), reported greater pain on the first postoperative day (p = 0.049), and exhibited more blood loss and drainage volume (p = 0.033, p = <0.001). Follow-up procedures were more frequent in the rib-resecting group (1, IQR 1-3) than in the rib-sparing group (1, IQR 0-1; p = 0.001), including lipofilling (35% vs. 20.3%, p = 0.029).

The rib-sparing approach shows significant advantages over rib-resection, particularly in terms of reduced postoperative morbidity and more aesthetically pleasing result with fewer secondary interventions. When technically feasible, it should be considered the preferred method in autologous breast reconstruction.Clinical Question/Level of Evidence.