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The significance of timing in breast reconstruction after mastectomy: an ACS-NSQIP analysis

Background - A variety of breast reconstruction (BR) options are available. The significance of timing on outcomes remains debated. This study aims to compare complications in breast cancer patients undergoing implant-based and autologous BR immediately after mastectomy or at a delayed time point. -...

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Main Authors: Knoedler, Samuel (Author) , Kauke-Navarro, Martin (Author) , Knoedler, Leonard (Author) , Friedrich, Sarah (Author) , Ayyala, Haripriya S. (Author) , Haug, Valentin (Author) , Didzun, Oliver (Author) , Hundeshagen, Gabriel (Author) , Bigdeli, Amir Khosrow (Author) , Kneser, Ulrich (Author) , Machens, Hans-Guenther (Author) , Pomahac, Bohdan (Author) , Orgill, Dennis P. (Author) , Broer, P. Niclas (Author) , Panayi, Adriana C. (Author)
Format: Article (Journal)
Language:English
Published: February 2024
In: Journal of plastic, reconstructive & aesthetic surgery
Year: 2024, Volume: 89, Pages: 40-50
ISSN:1878-0539
DOI:10.1016/j.bjps.2023.11.049
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.bjps.2023.11.049
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S1748681523007726
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Author Notes:Samuel Knoedler, Martin Kauke-Navarro, Leonard Knoedler, Sarah Friedrich, Haripriya S. Ayyala, Valentin Haug, Oliver Didzun, Gabriel Hundeshagen, Amir Bigdeli, Ulrich Kneser, Hans-Guenther Machens, Bohdan Pomahac, Dennis P. Orgill, P. Niclas Broer, Adriana C. Panayi
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Summary:Background - A variety of breast reconstruction (BR) options are available. The significance of timing on outcomes remains debated. This study aims to compare complications in breast cancer patients undergoing implant-based and autologous BR immediately after mastectomy or at a delayed time point. - Methods - We reviewed the ACS-NSQIP database (2008-2021) to identify all female patients who underwent BR for oncological purposes. Outcomes were stratified by technique (implant-based versus autologous) and timing (immediate versus delayed), and included 30-day mortality, reoperation, (unplanned) readmission, and surgical and medical complications. - Results - A total of 21,560 patients were included: 11,237 (52%) implant-based (9791/87% immediate, 1446/13% delayed) and 10,323 (48%) autologous (8378/81% immediate, 1945/19% delayed). Complications occurred in 3666 (17%) patients (implant-based: n = 1112/11% immediate, n = 64/4.4% delayed cohorts; Autologous: n = 2073/25% immediate, n = 417/21% delayed cohorts). In propensity score weighting (PSW) analyses, immediate BR was associated with significantly more complications than delayed BR (p < 0.0001). This was the case for both implant-based and autologous BR, with a greater difference between the two time points noted in implant-based. Confounder-adjusted multivariable analyses confirmed these results. - Conclusion - At the 30-day time point, delayed BR is associated with significantly lower complication rates than immediate BR, in both the implant-based and autologous cohorts. These findings are not a blanket recommendation in favor of immediate and/or delayed BR. Instead, our insights may guide surgeons and patients in decision-making and help refine patients’ eligibility in a case-by-case workup.
Item Description:Online verfügbar: 1. Dezember 2023, Artikelversion: 21. Dezember 2023
Gesehen am 18.03.2024
Physical Description:Online Resource
ISSN:1878-0539
DOI:10.1016/j.bjps.2023.11.049

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