Thromboembolic and Hemorrhagic Risks Following Mastectomy with versus without Direct-to-Implant Reconstruction

Résumé fourni par la source

Immediate direct-to-implant (DTI) breast reconstruction following mastectomy (MT) provides aesthetic and logistical advantages, including single-stage restoration and avoidance of tissue expansion. However, concerns persist that increased operative duration and procedural complexity may elevate thromboembolic and hemorrhagic risk. This study compared 90-day postoperative complication rates between MT vs. MT+DTI reconstruction. A multicenter cohort study was conducted using the TriNetX Research Network. Adult female patients with breast cancer undergoing MT with or without immediate DTI between 2010 and 2025 were included; autologous and staged reconstructions were excluded. Propensity score matching (1:1) balanced demographics, BMI, comorbidities, oncologic history, and preoperative medications. Outcomes included hematoma, acute deep vein thrombosis (DVT), and pulmonary embolism (PE). After matching, 11,538 patients (5,769 pairs) were analyzed. MT+DTI was associated with lower hematoma rates (0.94% vs. 1.40%; RR 0.675; 95% CI [0.48, 0.95]; p = 0.024) and fewer DVT events (0.38% vs. 0.83%; RR 0.458; 95% CI [0.28, 0.76]; p = 0.002). PE occurred in 0.29% of patients vs. 0.50% (RR 0.586; 95% CI [0.32, 1.07]; p = 0.076). Immediate DTI following MT was associated with lower short-term rates of hematoma and DVT, with a non-significant trend toward lower PE rates. These findings suggest that immediate DTI was not associated with increased short-term thromboembolic or hemorrhagic morbidity in this matched cohort. Given the limitations of coding-based observational data and potential residual confounding, prospective multicenter studies incorporating granular perioperative variables are required to confirm these associations and refine risk-stratified decision-making in reconstructive care.

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