Immediate Breast Reconstruction at a Multicenter Hospital: A Comprehensive Review of 279 cases

Abstract

Background: This study aims to evaluate and compare the outcomes and complications of various immediate breast reconstruction (IBR) techniques following mastectomy at Centro Hospitalar Universitário São João (CHUSJ) to identify correlations between these variables. Methods: A retrospective cohort study was conducted, auditing all women registered for mastectomy and immediate breast reconstruction (IBR) at the Breast Centre of CHUSJ from January 2021 to December 2023. Data were extracted from clinical records, focusing on surgical details, patient demographics, and complication rates. Statistical analyses, including univariate and multivariate analyses, were performed to identify significant differences and correlations. Results: A total of 279 IBRs were analyzed. Of these, 85.7% were heterologous reconstructions (57.1% with expanders, 28.6% with direct implants) and 10.7% were autologous (3.2% with DIEP, 7.5% with TRAM flaps). Immediate complications were observed in 48% of cases, with NAC necrosis being the most frequent (15%). Late complications occurred in 35.5% of IBRs, with asymmetry being the most common (9.3%). Mastectomies with a peri-areolar incision were more likely to require unexpected skin or NAC excision intraoperatively (66.7%). Statistically significant differences in immediate complications were not observed among different reconstructive techniques. However, direct implants and retromuscular expanders were associated with higher incidences of late complications. Conclusions: This study found no significant differences in immediate complication rates among various IBR techniques. However, late complications were more common in reconstructions involving direct implants and retromuscular expanders. This research contributes valuable data for improving breast reconstruction practices and patient education at CHUSJ and comparable institutions.