Immediate breast reconstruction versus delayed immediate breast reconstruction: A Strasbourg experience retrospective study.
BACKGROUND Delayed-immediate breast reconstruction (DIBR) using a temporary tissue expander is commonly recommended when post-mastectomy radiotherapy (PMRT) is anticipated, with the aim of optimizing aesthetic outcomes. However, the actual benefit of tissue expanders compared with immediate breast reconstruction (IBR) remains debated. METHODS We conducted a retrospective monocentric observational study including patients who underwent curative or prophylactic mastectomy followed by IBR or DIBR between January 2019 and December 2023. Reconstruction techniques included definitive implants, tissue expanders, and autologous flaps. The primary endpoint was aesthetic outcome assessed on standardized postoperative photographs using the Vrieling scale by six blinded plastic surgeons. Secondary endpoints included patient-reported outcomes using the BREAST-Q questionnaire, number of surgical procedures, capsular contracture (Baker classification), and postoperative complications (Clavien-Dindo). Multivariate analyses were performed to account for confounders, including radiotherapy. RESULTS A total of 149 patients (192 reconstructions) were included (160 IBR, 32 DIBR). No significant difference in aesthetic outcomes was observed between IBR and DIBR overall, nor within implant-based or flap-based subgroups. BREAST-Q scores were comparable between groups across psychosocial, sexual well-being, and breast satisfaction domains, although chest physical well-being was significantly lower in the DIBR group (P=0.03). Patients undergoing flap reconstruction reported higher breast satisfaction than those with implant-based reconstruction (P<0.001). DIBR required significantly more surgical procedures than IBR (2.3 vs. 1.6; P<0.001). Radiotherapy negatively impacted patient-reported satisfaction but did not significantly influence aesthetic scores or complication rates between groups. CONCLUSION Among patients who completed reconstruction, DIBR did not confer a measurable aesthetic advantage over IBR, while requiring more surgical procedures and being associated with lower chest physical well-being. Immediate reconstruction may be sufficient in selected patients, even when radiotherapy is required.