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

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

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish
Pages (from-to)40-50
Number of pages11
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
StatePublished - Feb 2024
Externally publishedYes


  • Autologous breast reconstruction
  • Big data
  • Breast cancer
  • Delayed breast reconstruction
  • Immediate breast reconstruction
  • Implant-based breast reconstruction


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