Current landscape and challenges in autologous breast reconstruction across China: A nationwide questionnaire-based survey of 198 hospitals.

Abstract

Autologous breast reconstruction (ABR) provides distinct aesthetic and functional advantages; however, its adoption in China remains relatively limited. This nationwide survey evaluated the current status, trends and institutional disparities in ABR practice across the country. A national cross-sectional survey was conducted in 2022 among 215 hospitals, with 198 valid responses (response rate = 92%). Data on institutional characteristics, reconstruction techniques, complications and influencing factors were collected and analysed. Among the hospitals performing breast reconstruction (n = 169), 110 (65.1%) offered ABR. The most common techniques were latissimus dorsi flaps (LDFs) (28.9%), LDF with implants (28.0%), pedicled transverse rectus abdominis myocutaneous (TRAM) (15.7%) and free abdominal flaps (12.9%). Compared with 2017, the use of LDF and pedicled TRAMs declined, whereas perforator-based procedures showed a notable rise. ABR was more prevalent in economically developed eastern regions and in hospitals equipped with plastic surgery departments. Considerable regional and institutional disparities persist in the availability and implementation of ABR. ABR is steadily increasing in China, accompanied by a gradual shift towards perforator-based techniques such as deep inferior epigastric artery perforator flaps. However, its provision remains concentrated in tertiary centres with strong surgical capacity and multidisciplinary support. Addressing regional disparities through targeted training, resource allocation, and standardised practice guidelines will be key to improving equity and quality in breast reconstruction nationwide.