A Global Propensity Score-matched Analysis of 56,992 Nicotine-dependent Versus Nondependent Breast Reconstruction...

Nicotine dependence is known to cause impaired wound healing and increase risk of surgical complications; nonetheless, the literature lacks evidence regarding the risks of capsular contracture and other implant-related complications.

A retrospective cohort study was conducted using data from the TriNetX global health research network. Patients undergoing breast reconstruction were categorized into 2 cohorts: those with nicotine dependence documented within 6 months before surgery and those without nicotine use.

Propensity score matching was performed, resulting in balanced cohorts of 28,496 patients each. The nicotine dependence cohort had a higher incidence of seroma formation (risk ratio [RR] = 1.224 [1.177-1.274]; P < 0.0001), hematoma (RR = 1.218 [1.170-1.268]; P < 0.0001), dehiscence (RR = 1.460 [1.362-1.564]; P < 0.0001), capsular contracture (RR = 1.167 [1.132-1.203]; P < 0.0001), implant-related mechanical complications (RR = 1.327 [1.245-1.414]; P < 0.0001), revision surgery (RR = 1.099 [1.074-1.125]; P < 0.0001), breast fat necrosis (RR = 1.251 [1.172-1.335]; P < 0.0001), and infection (RR = 1.340 [1.281-1.401]; P < 0.0001). There was no statistically significant difference (P > 0.05) between the 2 cohorts regarding postmastectomy lymphedema syndrome and flap loss or failure.

Nicotine dependence increases the risk of many surgical complications in breast reconstruction, consistent with previous studies. Interestingly, it also increases the risk of capsular contracture and other implant-related mechanical complications (malposition/displacement, rupture). These results emphasize the need for smoking and nicotine cessation before breast reconstruction.