Soft Tissue Support Use in Implant-Based Breast Reconstruction: A Nationwide, Cross-Sectional Study of Postoperative Complications.

Abstract

Use of soft tissue support in postmastectomy, implant-based breast reconstruction (IBBR) has become increasingly common. Although soft tissue support (STS) offers benefits in terms of stability and contour, in some instances, its use has been associated with increased postoperative complications. This study assesses rates of postoperative complications following IBBR with and without soft tissue support in a large, nationwide database. Using Epic Cosmos, a nationwide database of over 300 million patients, patients undergoing postmastectomy IBBR with implantation of a breast implant or tissue expander (CPT 19340) between 2015 and 2025 were identified. Patients were stratified by use of STS (CPT 15777). Primary outcomes included complications within 90 days of surgery: surgical site infection (SSI), seroma, hematoma, wound dehiscence, and implant loss. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for each complication, and P  < 0.05 was considered statistically significant. Among 66,862 patients undergoing IBBR, 32,680 (48.9%) received STS and 34,182 (51.1%) did not. Average BMI was higher in patients with STS (26.9 ± 5.80 vs 26.5 ± 5.74 kg/m 2 , P  < 0.05). STS was used less frequently among current smokers (3.7% vs 6.0%, P  < 0.05). Adjusting for age, BMI, smoking status, and type 2 diabetes status, STS use was associated with increased odds of surgical site infection (adjusted odds ratio [aOR], 3.89; 95% confidence interval [CI], 3.13-4.90; P  < 0.05), seroma (aOR, 2.38; 95% CI, 2.07-2.73; P  < 0.05), hematoma (aOR, 1.69; 95% CI, 1.46-1.95; P  < 0.05), wound dehiscence (aOR, 2.58; 95% CI, 2.31-2.89; P  < 0.05), and implant loss (aOR, 3.40; 95% CI, 3.00-3.88; P  < 0.05). In this nationwide cohort, use of soft tissue support in postmastectomy breast reconstruction was associated with a higher risk of select postoperative complications. These findings underscore the importance of patient selection and shared decision making when considering mesh in breast reconstruction, particularly in patients with modifiable comorbidities such as obesity or smoking.