Outpatient Immediate Breast Reconstruction Is Safe: National Trends and Propensity-Matched Outcomes from the ACS NSQIP, 2015–2023

Outpatient Immediate Breast Reconstruction Is Safe: National Trends and Propensity-Matched Outcomes from the ACS NSQIP, 2015–2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outpatient Immediate Breast Reconstruction Is Safe: National Trends and Propensity-Matched Outcomes from the ACS NSQIP, 2015–2023 Mark Xiao, John Tycher, Luanna Summer, Saif Badran, Justin Sacks This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9361371/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 7 You are reading this latest preprint version Abstract Background Immediate breast reconstruction is an established component of breast cancer care with demonstrated psychosocial and economic benefits. 1 , 2 Although outpatient reconstruction has expanded, concerns persist regarding its safety across reconstructive modalities. This study evaluates national trends and compares short-term outcomes of outpatient versus inpatient immediate breast reconstruction using propensity-matched analysis. Methods The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for mastectomy and breast reconstruction procedures from 2015–2023. Trends in reconstructive modality, care setting, and length of stay were assessed across three periods: pre-2020, 2020, and post-2020. Inpatient and outpatient cohorts were propensity score-matched using age, body mass index, diabetes mellitus, disseminated cancer, chronic steroid use, smoking history, and hypertension. Thirty-day postoperative outcomes were compared. Results A total of 118,535 breast reconstructions and 316,895 mastectomies were identified. Outpatient immediate reconstruction increased from 8.3% pre-2020 to 36.3% post-2020 for implant-based reconstruction and from 1.67% to 8.35% for autologous reconstruction. Mean postoperative length of stay decreased by 0.47 days (27.3%) over the same period. Despite this shift toward outpatient care, there was no increase in complications rates. In propensity-matched analysis, outpatient reconstruction was associated with lower rates of 30-day reoperation, hematoma/seroma, and blood transfusion compared with inpatient reconstruction across all time periods ( P < 0.001). Rates of surgical site infection, implant removal, wound dehiscence, and serious medical complications ranged from 0–6% and comparable between settings. Conclusions Outpatient immediate breast reconstruction has expanded significantly and demonstrates comparable short-term outcomes relative to inpatient care. When applied to appropriately selected patients, outpatient breast reconstruction is a safe and effective approach without an associated increase in postoperative complications. Figures Figure 1 Figure 2 Figure 3 Introduction Immediate breast reconstruction following mastectomy is an integral component of comprehensive breast cancer care, offering well-established psychosocial, aesthetic, and economic benefits. 1 , 2 Reconstructive options include implant-based techniques—direct-to-implant (DTI) and tissue expander reconstruction—as well as autologous approaches. 3 , 4 Historically, these procedures were performed in the inpatient setting to permit postoperative pain control and monitoring for complications such as hematoma and flap compromise. 3,4 Over the past decade, advances in surgical technique, anesthesia, and perioperative care pathways have enabled a gradual transition toward outpatient reconstruction. Prepectoral implant placement, acellular dermal matrix utilization, enhanced recovery protocols, and opioid-sparing regional anesthesia have reduced operative morbidity and facilitated earlier discharge. 5 – 8 Concurrently, broader healthcare system pressures emphasizing value-based care and resource optimization have further accelerated interest in ambulatory reconstructive pathways. 6 , 7 Although the COVID-19 pandemic hastened the adoption of outpatient surgery, it remains unclear whether this shift represents a temporary adaptation or a durable transformation in reconstructive practice. 9 – 13 Importantly, the long-term safety of outpatient immediate breast reconstruction across reconstructive modalities has not been comprehensively evaluated using contemporary national data. Demonstrating comparable outcomes between inpatient and outpatient settings is essential to guide patient selection and inform evolving standards of care. This study analyzes nine years of national NSQIP data to characterize trends in mastectomy and immediate breast reconstruction and to compare outcomes between inpatient and outpatient reconstruction using propensity-matched analysis. In particular, it evaluates whether the expansion of outpatient immediate breast reconstruction is associated with increased postoperative complications or achieves comparable short-term outcomes relative to inpatient care. Methods Study population This retrospective cohort study was approved by the Institutional Review Board of [redacted] with a waiver of informed consent. Deidentified data were obtained from the ACS NSQIP database from January 1, 2015, through December 31, 2023. Breast reconstruction procedures were identified using relevant CPT codes for implant-based reconstruction (19340, 19342, 19357) and autologous reconstruction (19361, 19364, 19367–19369). Mixed bilateral reconstructions (both autologous and implant-based) were categorized as autologous reconstructions. Mastectomy procedures were identified using the CPT codes 19301–19307. Immediate reconstruction was defined as reconstruction performed concurrently at the time of mastectomy. Data collection Demographic variables, including age, height, and weight were recorded, with body mass index (BMI) calculated from preoperative measures. Patient comorbidities included current smoking status, hypertension, chronic steroid use, history of disseminated cancer, chronic obstructive pulmonary disease, and congestive heart failure. The American Society of Anesthesiologists (ASA) physical status classification was also recorded. Perioperative variables included operative setting (inpatient versus outpatient), operative time, and total length of stay. Postoperative outcomes assessed within 30 days included hematoma/seroma, debridement or abscess, implant removal, wound dehiscence, surgical site infection, bleeding, deep venous thrombosis, pulmonary embolism, and pneumonia. Cases with missing data were excluded from analysis, and all outcomes were defined according to NSQIP criteria. Statistical analysis Procedures were grouped into three time periods: pre-2020 (2015–2019), 2020, and post-2020 (2021–2023). Continuous variables were compared using analysis of variance, while categorical variables were compared using chi-square testing. Propensity score matching was performed to adjust for baseline characteristics and potential confounders, including age, BMI, diabetes mellitus, disseminated cancer, chronic steroid use, smoking history, and hypertension. Outcomes were then compared between matched inpatient and outpatient cohorts within each time period. Statistical significance was defined as P < 0.05, and analyses were conducted using Stata version 17.0. Results National trends in breast reconstruction A total of 118,535 breast reconstructions and 316,895 mastectomies were identified between 2015 and 2023, including 75,052 immediate reconstructions. Mean postoperative length of stay following breast reconstruction decreased from 1.72 days in the pre-2020 period to 1.28 days in 2020 and remained low at 1.25 days post-2020. Outpatient immediate reconstruction increased across all reconstructive modalities. Outpatient implant-based reconstruction increased from 8.3% pre-2020 to 28.3% in 2020 and 36.3% post-2020. Outpatient autologous reconstruction increased from 1.67% pre-2020 to 8.35% post-2020, driven primarily by increased use of latissimus dorsi flap reconstruction ( Figure 1 ). Among mastectomy-only patients, the proportion of outpatient mastectomy increased from 51.8% pre-2020 to 62.0% in 2020 and 64.7% post-2020, with a corresponding decrease in postoperative length of stay. Patient demographics and comorbidity profiles remained stable across time periods. Propensity-matched outcomes Following propensity score matching, inpatient and outpatient cohorts were well balanced with respect to age, body mass index, diabetes mellitus, disseminated cancer, chronic steroid use, smoking history, and hypertension. Thirty-day reoperation Outpatient reconstruction demonstrated consistently lower 30-day reoperation rates compared with inpatient reconstruction in a propensity score-matched cohort. In the pre-2020 period, reoperation rates were 4.9% for outpatient reconstruction versus 6.7% for inpatient reconstruction ( P < 0.001). During 2020, rates were 4.8% versus 6.8%, respectively ( P < 0.001). In the post-2020 period, outpatient reconstruction continued to demonstrate lower reoperation rates despite increased outpatient surgical volume (5.0% vs 7.4%, P < 0.001) ( Figure 2 ). Hematoma and seroma Hematoma and seroma occurred more frequently in inpatient procedures across all time periods. Before 2020, rates were 1.7% for inpatient reconstruction versus 1.1% for outpatient reconstruction ( P < 0.001). During 2020, rates were 2.0% versus 1.0%, respectively ( P < 0.001). In the post-2020 period, hematoma/seroma rates remained higher among inpatient patients (2.1% vs 1.2%, P < 0.001). Blood transfusion Blood transfusion occurred at a similar rate in the pre-2020 period in a propensity score-matched cohort. Rates were 0.52% for inpatient reconstruction versus 0.26% for outpatient reconstruction ( P > 0.05). During 2020, severe bleeding occurred more frequently in the inpatient setting, 0.96% versus 0.1%, respectively ( P < 0.001). In the post-2020 period, severe bleeding rates remained higher among inpatient patients (1.1% vs 0.15%, P < 0.001). ( Figure 3 ). Surgical site infection, wound dehiscence, and implant removal There was no statistical difference in 30-day surgical site infection between the two cohorts (5.6 vs 5.2%). Wound dehiscence and implant removal occurred in 1% or less of patients in both matched cohorts, with no statistical difference between the two groups. Serious medical complications Serious medical complications, including deep vein thrombosis, pulmonary embolism, and pneumonia, occurred in less than 0.2% of patients in the propensity-matched cohorts. There was no clinical significance in the incidence of serious medical complications by care setting. Discussion This national analysis demonstrates that outpatient immediate breast reconstruction has expanded significantly and is associated with equivalent or improved short-term outcomes compared with inpatient reconstruction. Propensity-matched analysis confirms that outpatient reconstruction is not associated with increased morbidity and is instead associated with lower rates of reoperation, hematoma/seroma, and blood transfusion. Concerns regarding selection bias are frequently raised when interpreting outpatient surgical outcomes. By adjusting for key patient characteristics and comorbidities, our findings suggest that favorable outcomes are not solely attributable to patient selection. The consistency of these findings across time periods and reconstructive modalities supports the safety and durability of outpatient reconstructive pathways. Implant-based reconstruction accounted for the majority of outpatient growth and demonstrated the most consistent outcome advantages, consistent with prior studies supporting ambulatory alloplastic reconstruction. 7 , 9 , 12 Autologous reconstruction demonstrated fewer statistically significant differences, likely reflecting selective outpatient utilization and smaller matched cohorts. Notably, no complication category increased for outpatient autologous reconstruction in the post-2020 period, aligning with emerging evidence supporting ambulatory latissimus dorsi reconstruction. 14 – 16 The observed increase in outpatient autologous reconstruction likely reflects early-adopter behavior, and broader uptake may be expected as perioperative pathways continue to mature. Although a small increase in superficial surgical site infection has been reported in unmatched outpatient implant-based reconstruction, this did not translate into higher reoperation or implant loss rates in the present matched analysis. Existing evidence does not support prolonged antibiotic prophylaxis in breast reconstruction and suggests potential risks associated with extended antibiotic exposure. 17 Instead, optimized patient education, early postoperative surveillance, and timely intervention may represent more effective strategies for mitigating infection risk in the outpatient setting. Although NSQIP does not capture patient-reported outcomes nor long-term complication data, prior studies have demonstrated comparable or improved patient satisfaction following outpatient breast reconstruction, suggesting that observed safety advantages are not achieved at the expense of patient experience. Future studies incorporating patient-reported outcomes and longer-term follow-up will further clarify the impact of outpatient reconstruction on quality of life and aesthetic satisfaction. Taken together, these findings suggest that inpatient admission following immediate breast reconstruction should be reserved for patients with elevated perioperative risk rather than routine practice. Inpatient care may remain appropriate for individuals with significant cardiopulmonary disease, poorly controlled diabetes, high frailty burden, complex bilateral autologous reconstruction, or limited social support. Care setting decisions should therefore be individualized, balancing patient safety with the benefits of ambulatory recovery. Outpatient reconstruction represents a durable evolution in reconstructive care that aligns with contemporary goals of safety, efficiency, and patient-centered recovery. Conclusion Outpatient immediate breast reconstruction has expanded significantly at the national level and demonstrates comparable short-term safety to inpatient reconstruction when applied to appropriately selected patients. These findings support outpatient reconstruction as a safe and effective model of care delivery and suggest that routine inpatient admission following immediate reconstruction is no longer necessary for many patients. Declarations Competing Interests JMS is the cofounder of LifeSprout equity and patents. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Ethics statements This retrospective cohort study conducted in accordance with all rules and regulations of the Institutional Review Board (IRB) and human studies committee. IRB approval from [redacted] was obtained, and a waiver of written informed consent was obtained for this study. Clinical Trial Number Not applicable Author Contribution M.X. and J.T. were involved in conceptualization, writing the main manuscript text, and prepared all figures and tables. M.X. and J.T. contributed equally to the manuscript. L.S. contributed to statistical analysis and writing of the original draft. S.B. and J.S. contributed to conceptualization, supervision, and critical revision of manuscript. All authors reviewed the manuscript. Data Availability The data used in this study were obtained from the American College of Surgeons National Surgical Quality Improvement Program and are subject to data use agreements that prohibit public sharing. Researchers interested in accessing NSQIP data may apply directly through the American College of Surgeons. References Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW (2000) The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 26(1):17–19. 10.1053/ejso.1999.0733 Khoo AMD, Kroll SSMD, Reece GPMD, Miller MJMD, Schusterman MA (April 1998) M.D. A Comparison of Resource Costs of Immediate and Delayed Breast Reconstruction. Plast Reconstr Surg 101(4):964–968 Panchal H, Matros E (2017) Current Trends in Postmastectomy Breast Reconstruction. Plast Reconstr Surg . ;140(5S Advances in Breast Reconstruction):7S-13S. 10.1097/PRS.0000000000003941 Cemal Y, Albornoz CR, Disa JJ et al (2013) A paradigm shift in U.S. breast reconstruction: Part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg Mar 131(3):320e–326e. 10.1097/PRS.0b013e31827cf576 Johnson AC, Colakoglu S, Reddy A et al (2020) Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction. Anesth Pain Med Oct 10(5):e105686. 10.5812/aapm.105686 Shariq OA, Bews KA, Etzioni DA, Kendrick ML, Habermann EB, Thiels CA (2023) Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic. JAMA Netw Open Mar 01(3):e231198. 10.1001/jamanetworkopen.2023.1198 Qin C, Antony AK, Aggarwal A, Jordan S, Gutowski KA, Kim JY (2015) Assessing Outcomes and Safety of Inpatient Versus Outpatient Tissue Expander Immediate Breast Reconstruction. Ann Surg Oncol Oct 22(11):3724–3729. 10.1245/s10434-015-4407-5 Sohn SM, Lee HC, Park SH, Yoon ES (2023) Difference in the outcomes of anterior tenting and wrapping techniques for acellular dermal matrix coverage in prepectoral breast reconstruction. J Plast Reconstr Aesthet Surg 85:266–275. 10.1016/j.bjps.2023.06.070 Chiang SN, Finnan MJ, Skolnick GB, Sacks JM, Christensen JM (2022) The impact of the COVID-19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes. J Surg Oncol Aug 126(2):195–204. 10.1002/jso.26883 Hemal K, Boyd CJ, Bekisz JM, Salibian AA, Choi M, Karp NS (2021) Breast Reconstruction during the COVID-19 Pandemic: A Systematic Review. Plast Reconstr Surg Glob Open Sep 9(9):e3852. 10.1097/GOX.0000000000003852 Rubenstein RN, Stern CS, Plotsker EL et al (2022) Effects of COVID-19 on mastectomy and breast reconstruction rates: A national surgical sample. J Surg Oncol Aug 126(2):205–213. 10.1002/jso.26889 Little AK, Patmon DL, Sandhu H, Armstrong S, Anderson D, Sommers M (2023) Inpatient versus Outpatient Immediate Alloplastic Breast Reconstruction: Recent Trends, Outcomes, and Safety. Plast Reconstr Surg Glob Open 11(9):e5135 Published 2023 Sep 21. 10.1097/GOX.0000000000005135 Hong SE, Kang D (2024) Navigating the Pandemic: Shifts in Breast Reconstruction Trends and Surgical Decision-Making in the United States. J Clin Med. ;13(14):4168. Published 2024 Jul 16. 10.3390/jcm13144168 Sakharpe AK, Cook J, Newman MI, Barnavon Y (2020) The muscle sparing latissimus dorsi (MSLD) flap for secondary breast reconstruction based on reverse flow from intercostal vessels. J Plast Reconstr Aesthet Surg 73(1):184–199. 10.1016/j.bjps.2019.05.053 Davidge K, Armstrong KA, Brown M et al (2015) Shifting Autologous Breast Reconstruction into an Ambulatory Setting: Patient-Reported Quality of Recovery. Plast Reconstr Surg Oct 136(4):657–665. 10.1097/PRS.0000000000001575 Ayyala HSMD, Atamian EKMD, Le, Thuy-My TMSE, Cohen, Stephanie MD Autologous Can Be Ambulatory: The Outpatient Latissimus Dorsi Myocutaneous Flap for Breast Reconstruction. Plastic and Reconstructive Surgery 147(2):p 361e-362e, February 2021. | 10.1097/PRS.0000000000007567 Aldarragi A, Farah N, Warner CM et al (2023) The Duration of Postoperative Antibiotics in Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis. Cureus 15(6):e40631 Published 2023 Jun 19. 10.7759/cureus.40631 Tables Table 1. Baseline Characteristics of Immediate Reconstruction Patients by Time Period 2020 Age 50.93 (11.23) 50.47 (11.44) 50.67 (11.39) Body Mass Index (BMI) 27.93 (6.22) 28.16 (6.24) 28.33 (6.13) Postop Length of Stay 1.72 (1.93) 1.28 (1.46) 1.25 (1.53) Outpatient 2,775 ( 7.3%) 1,756 (24.3%) 7,089 (30.8%) Current Smoker 3,421 ( 8.9%) 520 ( 7.2%) 1,552 ( 6.8%) Hypertension 8,744 (22.9%) 1,664 (23.1%) 5,369 (23.4%) Steroid Use 741 ( 1.9%) 169 ( 2.3%) 869 ( 3.8%) Disseminated Cancer 581 ( 1.5%) 75 ( 1.0%) 268 ( 1.2%) History of COPD 234 ( 0.6%) 39 ( 0.5%) 123 ( 0.5%) History of CHF 25 ( 0.1%) 4 ( 0.1%) 90 ( 0.4%) Diabetes 546 ( 1.4%) 114 ( 1.6%) 337 ( 1.5%) ASA Physical Status 1 2,619 ( 6.8%) 382 ( 5.3%) 912 ( 4.0%) 2 25,900 (67.7%) 4,634 (64.3%) 14,138 (61.5%) 3 9,645 (25.2%) 2,171 (30.1%) 7,832 (34.1%) 4 100 ( 0.3%) 24 ( 0.3%) 105 ( 0.5%) 5 0 ( 0.0%) 1 ( 0.0%) 1 ( 0.0%) Implant Reconstruction 32,037 (83.7%) 6,124 (84.9%) 18,474 (80.4%) Outpatient 2,671 ( 8.3%) 1,731 (28.3%) 6,712 (36.3%) Direct-to-Implant 5,907 (18.4%) 1,266 (20.7%) 4,102 (22.2%) Immediate Tissue Expander 25,793 (80.5%) 4,769 (77.9%) 14,128 (76.5%) Implant and Expander (Bilateral) 337 ( 1.1%) 89 ( 1.5%) 244 ( 1.3%) Prepectoral 16,052 (50.1%) 2,297 (37.5%) 6,977 (37.8%) Subpectoral 15,985 (49.9%) 3,827 (62.5%) 11,497 (62.2%) Flap Reconstruction 6,227 (16.3%) 1,088 (15.1%) 4,514 (19.6%) Outpatient 104 (1.67%) 25 (2.3%) 377 (8.35%) Latissimus Dorsi Flap 1,042 (16.7%) 129 (11.9%) 379 ( 8.4%) N N=38,264 N=7,212 N=22,988 Data are expressed in N(%) or Mean(SD) Table 2. Thirty-day complications after immediate breast reconstruction (all patients) Related reoperation 5,204 (7.5%) Hematoma/Seroma 1,421 (2.0%) Abscess/Debridement 53 (0.1%) Implant removal 200 (0.3%) Dehiscence 712 (1.0%) Severe bleeding 1,415 (2.0%) SSI 3,760 (5.4%) DVT 220 (0.3%) PE 185 (0.3%) Pneumonia 72 (0.1%) Data are expressed in N(%) Table 3. Propensity-matched thirty-day outcomes for inpatient versus outpatient immediate breast reconstruction. Inpatient Outpatient p-value N=11,619 N=11,619 Related reoperation 855 ( 7.4%) 567 ( 4.9%) <0.001 Hematoma/Seroma 242 ( 2.1%) 131 ( 1.1%) <0.001 Abscess/Debridement 10 ( 0.1%) 4 ( 0.0%) 0.11 Implant removal 50 ( 0.4%) 35 ( 0.3%) 0.10 Dehiscence 93 ( 0.8%) 118 ( 1.0%) 0.084 Severe bleeding 142 ( 1.2%) 21 ( 0.2%) <0.001 SSI 652 ( 5.6%) 604 ( 5.2%) 0.16 DVT 27 ( 0.2%) 21 ( 0.2%) 0.39 PE 25 ( 0.2%) 12 ( 0.1%) 0.032 Pneumonia 5 ( 0.0%) 7 ( 0.1%) 0.56 Data are expressed in N(%) Additional Declarations Competing interest reported. JMS is the cofounder of LifeSprout equity and patents. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 03 May, 2026 Reviews received at journal 28 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor assigned by journal 12 Apr, 2026 Submission checks completed at journal 12 Apr, 2026 First submitted to journal 08 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9361371","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631016960,"identity":"2ea11755-7b99-4077-a0ae-4fffbf644de9","order_by":0,"name":"Mark Xiao","email":"","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":false,"prefix":"","firstName":"Mark","middleName":"","lastName":"Xiao","suffix":""},{"id":631016961,"identity":"74bab549-8c9e-420b-a090-577c163889fb","order_by":1,"name":"John Tycher","email":"","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Tycher","suffix":""},{"id":631016962,"identity":"d3533168-d73c-4fdf-9fd7-d9a32bf76611","order_by":2,"name":"Luanna Summer","email":"","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":false,"prefix":"","firstName":"Luanna","middleName":"","lastName":"Summer","suffix":""},{"id":631016963,"identity":"6a4cebf7-dbf9-43f3-9cf0-7e7a722d83d3","order_by":3,"name":"Saif Badran","email":"","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":false,"prefix":"","firstName":"Saif","middleName":"","lastName":"Badran","suffix":""},{"id":631016964,"identity":"9cf0a6a6-a1e2-4f87-9c55-6b4051bb86db","order_by":4,"name":"Justin Sacks","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYBACxgYQeYBBDsx7ABMgRosxmJ1AjBYIOMCQ2EC0FuZpxx9++HGmLn3DjfTnDxIYbGQ3HCDksNk5xpI9Nw7nbriRYwi0Jc2YGC0M0gwfDuRuu5EDctjhRCK0pD/+zfChLt3sRvpDoJb/xGhJMJNmuMGcYHYjAeSwA8RoyTGz7Dlz2HD/mTeGMxIMko1nEtJiCHTYjR/H6uQl29MffPhQYSfbR1BLAwrXgIByEJAnQs0oGAWjYBSMdAAAOBBN/zauVNQAAAAASUVORK5CYII=","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":true,"prefix":"","firstName":"Justin","middleName":"","lastName":"Sacks","suffix":""}],"badges":[],"createdAt":"2026-04-08 22:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9361371/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9361371/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108493201,"identity":"b8c2aacf-28e9-46de-b375-ab3f49982c41","added_by":"auto","created_at":"2026-05-05 09:59:37","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":213977,"visible":true,"origin":"","legend":"\u003cp\u003eNational trends in outpatient immediate breast reconstruction by reconstructive modality, 2015–2023.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9361371/v1/cf5522b82a3aacef9308676b.jpeg"},{"id":108389234,"identity":"6e96a340-ffe0-4753-86cd-675f657d9320","added_by":"auto","created_at":"2026-05-04 06:48:46","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104690,"visible":true,"origin":"","legend":"\u003cp\u003ePropensity-matched 30-day reoperation rates for inpatient versus outpatient immediate breast reconstruction across time periods.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9361371/v1/20b19daa8270579d71f9c645.jpeg"},{"id":108389235,"identity":"e0a72f39-5961-4fe2-b95b-75e64b7f27a7","added_by":"auto","created_at":"2026-05-04 06:48:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47025,"visible":true,"origin":"","legend":"\u003cp\u003ePropensity-matched hematoma/seroma rates for inpatient versus outpatient immediate breast reconstruction across time periods.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-9361371/v1/bcab1dd7d4857dce554faa80.png"},{"id":108494723,"identity":"0c3839db-bbad-4ba2-a0ae-ae558307095f","added_by":"auto","created_at":"2026-05-05 10:06:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":656550,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9361371/v1/e406784d-1d8e-438b-9ced-2cdb3995c260.pdf"}],"financialInterests":"Competing interest reported. JMS is the cofounder of LifeSprout equity and patents.","formattedTitle":"Outpatient Immediate Breast Reconstruction Is Safe: National Trends and Propensity-Matched Outcomes from the ACS NSQIP, 2015–2023","fulltext":[{"header":"Introduction","content":"\u003cp\u003eImmediate breast reconstruction following mastectomy is an integral component of comprehensive breast cancer care, offering well-established psychosocial, aesthetic, and economic benefits.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Reconstructive options include implant-based techniques\u0026mdash;direct-to-implant (DTI) and tissue expander reconstruction\u0026mdash;as well as autologous approaches.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Historically, these procedures were performed in the inpatient setting to permit postoperative pain control and monitoring for complications such as hematoma and flap compromise. \u003csup\u003e3,4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOver the past decade, advances in surgical technique, anesthesia, and perioperative care pathways have enabled a gradual transition toward outpatient reconstruction. Prepectoral implant placement, acellular dermal matrix utilization, enhanced recovery protocols, and opioid-sparing regional anesthesia have reduced operative morbidity and facilitated earlier discharge.\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Concurrently, broader healthcare system pressures emphasizing value-based care and resource optimization have further accelerated interest in ambulatory reconstructive pathways.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough the COVID-19 pandemic hastened the adoption of outpatient surgery, it remains unclear whether this shift represents a temporary adaptation or a durable transformation in reconstructive practice.\u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Importantly, the long-term safety of outpatient immediate breast reconstruction across reconstructive modalities has not been comprehensively evaluated using contemporary national data. Demonstrating comparable outcomes between inpatient and outpatient settings is essential to guide patient selection and inform evolving standards of care.\u003c/p\u003e \u003cp\u003eThis study analyzes nine years of national NSQIP data to characterize trends in mastectomy and immediate breast reconstruction and to compare outcomes between inpatient and outpatient reconstruction using propensity-matched analysis. In particular, it evaluates whether the expansion of outpatient immediate breast reconstruction is associated with increased postoperative complications or achieves comparable short-term outcomes relative to inpatient care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study was approved by the Institutional Review Board of [redacted] with a waiver of informed consent. Deidentified data were obtained from the ACS NSQIP database from January 1, 2015, through December 31, 2023.\u003c/p\u003e\n\u003cp\u003eBreast reconstruction procedures were identified using relevant CPT codes for implant-based reconstruction (19340, 19342, 19357) and autologous reconstruction (19361, 19364, 19367\u0026ndash;19369). Mixed bilateral reconstructions (both autologous and implant-based) were categorized as autologous reconstructions. Mastectomy procedures were identified using the CPT codes 19301\u0026ndash;19307. Immediate reconstruction was defined as reconstruction performed concurrently at the time of mastectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic variables, including age, height, and weight were recorded, with body mass index (BMI) calculated from preoperative measures. Patient comorbidities included current smoking status, hypertension, chronic steroid use, history of disseminated cancer, chronic obstructive pulmonary disease, and congestive heart failure. The American Society of Anesthesiologists (ASA) physical status classification was also recorded.\u003c/p\u003e\n\u003cp\u003ePerioperative variables included operative setting (inpatient versus outpatient), operative time, and total length of stay. Postoperative outcomes assessed within 30 days included hematoma/seroma, debridement or abscess, implant removal, wound dehiscence, surgical site infection, bleeding, deep venous thrombosis, pulmonary embolism, and pneumonia. Cases with missing data were excluded from analysis, and all outcomes were defined according to NSQIP criteria. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProcedures were grouped into three time periods: pre-2020 (2015\u0026ndash;2019), 2020, and post-2020 (2021\u0026ndash;2023). Continuous variables were compared using analysis of variance, while categorical variables were compared using chi-square testing.\u003c/p\u003e\n\u003cp\u003ePropensity score matching was performed to adjust for baseline characteristics and potential confounders, including age, BMI, diabetes mellitus, disseminated cancer, chronic steroid use, smoking history, and hypertension. Outcomes were then compared between matched inpatient and outpatient cohorts within each time period. Statistical significance was defined as P \u0026lt; 0.05, and analyses were conducted using Stata version 17.0.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eNational trends in breast reconstruction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 118,535 breast reconstructions and 316,895 mastectomies were identified between 2015 and 2023, including 75,052 immediate reconstructions. Mean postoperative length of stay following breast reconstruction decreased from 1.72 days in the pre-2020 period to 1.28 days in 2020 and remained low at 1.25 days post-2020.\u003c/p\u003e\n\u003cp\u003eOutpatient immediate reconstruction increased across all reconstructive modalities. Outpatient implant-based reconstruction increased from 8.3% pre-2020 to 28.3% in 2020 and 36.3% post-2020. Outpatient autologous reconstruction increased from 1.67% pre-2020 to 8.35% post-2020, driven primarily by increased use of latissimus dorsi flap reconstruction (\u003cstrong\u003eFigure 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eAmong mastectomy-only patients, the proportion of outpatient mastectomy increased from 51.8% pre-2020 to 62.0% in 2020 and 64.7% post-2020, with a corresponding decrease in postoperative length of stay. Patient demographics and comorbidity profiles remained stable across time periods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePropensity-matched outcomes\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Following propensity score matching, inpatient and outpatient cohorts were well balanced with respect to age, body mass index, diabetes mellitus, disseminated cancer, chronic steroid use, smoking history, and hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThirty-day reoperation\u003c/strong\u003e\u003cbr\u003eOutpatient reconstruction demonstrated consistently lower 30-day reoperation rates compared with inpatient reconstruction in a propensity score-matched cohort. In the pre-2020 period, reoperation rates were 4.9% for outpatient reconstruction versus 6.7% for inpatient reconstruction (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). During 2020, rates were 4.8% versus 6.8%, respectively (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). In the post-2020 period, outpatient reconstruction continued to demonstrate lower reoperation rates despite increased outpatient surgical volume (5.0% vs 7.4%, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) (\u003cstrong\u003eFigure 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHematoma and seroma\u003c/strong\u003e\u003cbr\u003eHematoma and seroma occurred more frequently in inpatient procedures across all time periods. Before 2020, rates were 1.7% for inpatient reconstruction versus 1.1% for outpatient reconstruction (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). During 2020, rates were 2.0% versus 1.0%, respectively (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). In the post-2020 period, hematoma/seroma rates remained higher among inpatient patients (2.1% vs 1.2%, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBlood transfusion\u003c/strong\u003e\u003cbr\u003eBlood transfusion occurred at a similar rate in the pre-2020 period in a propensity score-matched cohort. Rates were 0.52% for inpatient reconstruction versus 0.26% for outpatient reconstruction (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). During 2020, severe bleeding occurred more frequently in the inpatient setting, 0.96% versus 0.1%, respectively (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). In the post-2020 period, severe bleeding rates remained higher among inpatient patients (1.1% vs 0.15%, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). (\u003cstrong\u003eFigure 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical site infection, wound dehiscence, and implant removal\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;There was no statistical difference in 30-day surgical site infection between the two cohorts (5.6 vs 5.2%). Wound dehiscence and implant removal occurred in 1% or less of patients in both matched cohorts, with no statistical difference between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSerious medical complications\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Serious medical complications, including deep vein thrombosis, pulmonary embolism, and pneumonia, occurred in less than 0.2% of patients in the propensity-matched cohorts. There was no clinical significance in the incidence of serious medical complications by care setting.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis national analysis demonstrates that outpatient immediate breast reconstruction has expanded significantly and is associated with equivalent or improved short-term outcomes compared with inpatient reconstruction. Propensity-matched analysis confirms that outpatient reconstruction is not associated with increased morbidity and is instead associated with lower rates of reoperation, hematoma/seroma, and blood transfusion.\u003c/p\u003e \u003cp\u003eConcerns regarding selection bias are frequently raised when interpreting outpatient surgical outcomes. By adjusting for key patient characteristics and comorbidities, our findings suggest that favorable outcomes are not solely attributable to patient selection. The consistency of these findings across time periods and reconstructive modalities supports the safety and durability of outpatient reconstructive pathways.\u003c/p\u003e \u003cp\u003eImplant-based reconstruction accounted for the majority of outpatient growth and demonstrated the most consistent outcome advantages, consistent with prior studies supporting ambulatory alloplastic reconstruction.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Autologous reconstruction demonstrated fewer statistically significant differences, likely reflecting selective outpatient utilization and smaller matched cohorts. Notably, no complication category increased for outpatient autologous reconstruction in the post-2020 period, aligning with emerging evidence supporting ambulatory latissimus dorsi reconstruction.\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The observed increase in outpatient autologous reconstruction likely reflects early-adopter behavior, and broader uptake may be expected as perioperative pathways continue to mature.\u003c/p\u003e \u003cp\u003eAlthough a small increase in superficial surgical site infection has been reported in unmatched outpatient implant-based reconstruction, this did not translate into higher reoperation or implant loss rates in the present matched analysis. Existing evidence does not support prolonged antibiotic prophylaxis in breast reconstruction and suggests potential risks associated with extended antibiotic exposure.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Instead, optimized patient education, early postoperative surveillance, and timely intervention may represent more effective strategies for mitigating infection risk in the outpatient setting.\u003c/p\u003e \u003cp\u003eAlthough NSQIP does not capture patient-reported outcomes nor long-term complication data, prior studies have demonstrated comparable or improved patient satisfaction following outpatient breast reconstruction, suggesting that observed safety advantages are not achieved at the expense of patient experience. Future studies incorporating patient-reported outcomes and longer-term follow-up will further clarify the impact of outpatient reconstruction on quality of life and aesthetic satisfaction.\u003c/p\u003e \u003cp\u003eTaken together, these findings suggest that inpatient admission following immediate breast reconstruction should be reserved for patients with elevated perioperative risk rather than routine practice. Inpatient care may remain appropriate for individuals with significant cardiopulmonary disease, poorly controlled diabetes, high frailty burden, complex bilateral autologous reconstruction, or limited social support. Care setting decisions should therefore be individualized, balancing patient safety with the benefits of ambulatory recovery. Outpatient reconstruction represents a durable evolution in reconstructive care that aligns with contemporary goals of safety, efficiency, and patient-centered recovery.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOutpatient immediate breast reconstruction has expanded significantly at the national level and demonstrates comparable short-term safety to inpatient reconstruction when applied to appropriately selected patients. These findings support outpatient reconstruction as a safe and effective model of care delivery and suggest that routine inpatient admission following immediate reconstruction is no longer necessary for many patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eJMS is the cofounder of LifeSprout equity and patents.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003ch2\u003eEthics statements\u003c/h2\u003e\n\u003cp\u003eThis retrospective cohort study conducted in accordance with all rules and regulations of the Institutional Review Board (IRB) and human studies committee. IRB approval from [redacted] was obtained, and a waiver of written informed consent was obtained for this study.\u003c/p\u003e\n\u003ch2\u003eClinical Trial Number\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eM.X. and J.T. were involved in conceptualization, writing the main manuscript text, and prepared all figures and tables. M.X. and J.T. contributed equally to the manuscript. L.S. contributed to statistical analysis and writing of the original draft. S.B. and J.S. contributed to conceptualization, supervision, and critical revision of manuscript. All authors reviewed the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data used in this study were obtained from the American College of Surgeons National Surgical Quality Improvement Program and are subject to data use agreements that prohibit public sharing. Researchers interested in accessing NSQIP data may apply directly through the American College of Surgeons.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAl-Ghazal SK, Sully L, Fallowfield L, Blamey RW (2000) The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 26(1):17\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/ejso.1999.0733\u003c/span\u003e\u003cspan address=\"10.1053/ejso.1999.0733\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoo AMD, Kroll SSMD, Reece GPMD, Miller MJMD, Schusterman MA (April 1998) M.D. A Comparison of Resource Costs of Immediate and Delayed Breast Reconstruction. Plast Reconstr Surg 101(4):964\u0026ndash;968\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePanchal H, Matros E (2017) Current Trends in Postmastectomy Breast Reconstruction. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e. ;140(5S Advances in Breast Reconstruction):7S-13S. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PRS.0000000000003941\u003c/span\u003e\u003cspan address=\"10.1097/PRS.0000000000003941\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCemal Y, Albornoz CR, Disa JJ et al (2013) A paradigm shift in U.S. breast reconstruction: Part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg Mar 131(3):320e\u0026ndash;326e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PRS.0b013e31827cf576\u003c/span\u003e\u003cspan address=\"10.1097/PRS.0b013e31827cf576\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson AC, Colakoglu S, Reddy A et al (2020) Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction. Anesth Pain Med Oct 10(5):e105686. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5812/aapm.105686\u003c/span\u003e\u003cspan address=\"10.5812/aapm.105686\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShariq OA, Bews KA, Etzioni DA, Kendrick ML, Habermann EB, Thiels CA (2023) Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic. JAMA Netw Open Mar 01(3):e231198. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2023.1198\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2023.1198\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin C, Antony AK, Aggarwal A, Jordan S, Gutowski KA, Kim JY (2015) Assessing Outcomes and Safety of Inpatient Versus Outpatient Tissue Expander Immediate Breast Reconstruction. Ann Surg Oncol Oct 22(11):3724\u0026ndash;3729. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1245/s10434-015-4407-5\u003c/span\u003e\u003cspan address=\"10.1245/s10434-015-4407-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSohn SM, Lee HC, Park SH, Yoon ES (2023) Difference in the outcomes of anterior tenting and wrapping techniques for acellular dermal matrix coverage in prepectoral breast reconstruction. J Plast Reconstr Aesthet Surg 85:266\u0026ndash;275. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bjps.2023.06.070\u003c/span\u003e\u003cspan address=\"10.1016/j.bjps.2023.06.070\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiang SN, Finnan MJ, Skolnick GB, Sacks JM, Christensen JM (2022) The impact of the COVID-19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes. J Surg Oncol Aug 126(2):195\u0026ndash;204. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jso.26883\u003c/span\u003e\u003cspan address=\"10.1002/jso.26883\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHemal K, Boyd CJ, Bekisz JM, Salibian AA, Choi M, Karp NS (2021) Breast Reconstruction during the COVID-19 Pandemic: A Systematic Review. Plast Reconstr Surg Glob Open Sep 9(9):e3852. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/GOX.0000000000003852\u003c/span\u003e\u003cspan address=\"10.1097/GOX.0000000000003852\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubenstein RN, Stern CS, Plotsker EL et al (2022) Effects of COVID-19 on mastectomy and breast reconstruction rates: A national surgical sample. J Surg Oncol Aug 126(2):205\u0026ndash;213. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jso.26889\u003c/span\u003e\u003cspan address=\"10.1002/jso.26889\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLittle AK, Patmon DL, Sandhu H, Armstrong S, Anderson D, Sommers M (2023) Inpatient versus Outpatient Immediate Alloplastic Breast Reconstruction: Recent Trends, Outcomes, and Safety. Plast Reconstr Surg Glob Open 11(9):e5135 Published 2023 Sep 21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/GOX.0000000000005135\u003c/span\u003e\u003cspan address=\"10.1097/GOX.0000000000005135\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong SE, Kang D (2024) Navigating the Pandemic: Shifts in Breast Reconstruction Trends and Surgical Decision-Making in the United States. J Clin Med. ;13(14):4168. Published 2024 Jul 16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm13144168\u003c/span\u003e\u003cspan address=\"10.3390/jcm13144168\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakharpe AK, Cook J, Newman MI, Barnavon Y (2020) The muscle sparing latissimus dorsi (MSLD) flap for secondary breast reconstruction based on reverse flow from intercostal vessels. J Plast Reconstr Aesthet Surg 73(1):184\u0026ndash;199. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bjps.2019.05.053\u003c/span\u003e\u003cspan address=\"10.1016/j.bjps.2019.05.053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavidge K, Armstrong KA, Brown M et al (2015) Shifting Autologous Breast Reconstruction into an Ambulatory Setting: Patient-Reported Quality of Recovery. Plast Reconstr Surg Oct 136(4):657\u0026ndash;665. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PRS.0000000000001575\u003c/span\u003e\u003cspan address=\"10.1097/PRS.0000000000001575\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyyala HSMD, Atamian EKMD, Le, Thuy-My TMSE, Cohen, Stephanie MD Autologous Can Be Ambulatory: The Outpatient Latissimus Dorsi Myocutaneous Flap for Breast Reconstruction. Plastic and Reconstructive Surgery 147(2):p 361e-362e, February 2021. | \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PRS.0000000000007567\u003c/span\u003e\u003cspan address=\"10.1097/PRS.0000000000007567\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldarragi A, Farah N, Warner CM et al (2023) The Duration of Postoperative Antibiotics in Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis. Cureus 15(6):e40631 Published 2023 Jun 19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.40631\u003c/span\u003e\u003cspan address=\"10.7759/cureus.40631\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Baseline Characteristics of Immediate Reconstruction Patients by Time Period\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026lt; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026gt; 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e50.93 (11.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e50.47 (11.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e50.67 (11.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eBody Mass Index (BMI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e27.93 (6.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e28.16 (6.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e28.33 (6.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003ePostop Length of Stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1.72 (1.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.28 (1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1.25 (1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2,775 ( 7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1,756 (24.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7,089 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eCurrent Smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3,421 ( 8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e520 ( 7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1,552 ( 6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e8,744 (22.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1,664 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e5,369 (23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eSteroid Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e741 ( 1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e169 ( 2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e869 ( 3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eDisseminated Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e581 ( 1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e75 ( 1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e268 ( 1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eHistory of COPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e234 ( 0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e39 ( 0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e123 ( 0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eHistory of CHF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e25 ( 0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4 ( 0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e90 ( 0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e546 ( 1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e114 ( 1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e337 ( 1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eASA Physical Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2,619 ( 6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e382 ( 5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e912 ( 4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e25,900 (67.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4,634 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e14,138 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e9,645 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2,171 (30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7,832 (34.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e100 ( 0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e24 ( 0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e105 ( 0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 ( 0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1 ( 0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1 ( 0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eImplant Reconstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e32,037 (83.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6,124 (84.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e18,474 (80.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2,671 ( 8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1,731 (28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6,712 (36.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eDirect-to-Implant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e5,907 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1,266 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4,102 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eImmediate Tissue Expander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e25,793 (80.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4,769 (77.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e14,128 (76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eImplant and Expander (Bilateral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e337 ( 1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e89 ( 1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e244 ( 1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003ePrepectoral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e16,052 (50.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2,297 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6,977 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eSubpectoral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e15,985 (49.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3,827 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e11,497 (62.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;Flap Reconstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6,227 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1,088 (15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4,514 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e104 (1.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e25 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e377 (8.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eLatissimus Dorsi Flap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1,042 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e129 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e379 ( 8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003eN=38,264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003eN=7,212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003eN=22,988\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 339px;\"\u003e\n \u003cp\u003eData are expressed in N(%) or Mean(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2.\u0026nbsp;Thirty-day complications after immediate breast reconstruction (all patients)\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003eRelated reoperation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e5,204 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003eHematoma/Seroma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1,421 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAbscess/Debridement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e53 (0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003eImplant removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e200 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003eDehiscence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e712 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003eSevere bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1,415 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003eSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e3,760 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003eDVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e220 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e185 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e72 (0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 352px;\"\u003e\n \u003cp\u003eData are expressed in N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3.\u0026nbsp;Propensity-matched thirty-day outcomes for inpatient versus outpatient immediate breast reconstruction.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003eInpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003eN=11,619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eN=11,619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eRelated reoperation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e855 ( 7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e567 ( 4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eHematoma/Seroma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e242 ( 2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e131 ( 1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eAbscess/Debridement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e10 ( 0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4 ( 0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eImplant removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e50 ( 0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e35 ( 0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eDehiscence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e93 ( 0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e118 ( 1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eSevere bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e142 ( 1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e21 ( 0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e652 ( 5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e604 ( 5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003eDVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e27 ( 0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e21 ( 0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003ePE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e25 ( 0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e12 ( 0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 149px;\"\u003e\n \u003cp\u003e5 ( 0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e7 ( 0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 340px;\"\u003e\n \u003cp\u003eData are expressed in N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9361371/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9361371/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eImmediate breast reconstruction is an established component of breast cancer care with demonstrated psychosocial and economic benefits.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Although outpatient reconstruction has expanded, concerns persist regarding its safety across reconstructive modalities. This study evaluates national trends and compares short-term outcomes of outpatient versus inpatient immediate breast reconstruction using propensity-matched analysis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for mastectomy and breast reconstruction procedures from 2015\u0026ndash;2023. Trends in reconstructive modality, care setting, and length of stay were assessed across three periods: pre-2020, 2020, and post-2020. Inpatient and outpatient cohorts were propensity score-matched using age, body mass index, diabetes mellitus, disseminated cancer, chronic steroid use, smoking history, and hypertension. Thirty-day postoperative outcomes were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 118,535 breast reconstructions and 316,895 mastectomies were identified. Outpatient immediate reconstruction increased from 8.3% pre-2020 to 36.3% post-2020 for implant-based reconstruction and from 1.67% to 8.35% for autologous reconstruction. Mean postoperative length of stay decreased by 0.47 days (27.3%) over the same period. Despite this shift toward outpatient care, there was no increase in complications rates. In propensity-matched analysis, outpatient reconstruction was associated with lower rates of 30-day reoperation, hematoma/seroma, and blood transfusion compared with inpatient reconstruction across all time periods (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Rates of surgical site infection, implant removal, wound dehiscence, and serious medical complications ranged from 0\u0026ndash;6% and comparable between settings.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOutpatient immediate breast reconstruction has expanded significantly and demonstrates comparable short-term outcomes relative to inpatient care. When applied to appropriately selected patients, outpatient breast reconstruction is a safe and effective approach without an associated increase in postoperative complications.\u003c/p\u003e","manuscriptTitle":"Outpatient Immediate Breast Reconstruction Is Safe: National Trends and Propensity-Matched Outcomes from the ACS NSQIP, 2015–2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 06:48:37","doi":"10.21203/rs.3.rs-9361371/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-03T13:11:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T11:20:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285757715409010989119450988129203939844","date":"2026-04-23T16:27:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T12:54:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-13T02:12:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-13T02:12:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Plastic Surgery","date":"2026-04-08T22:49:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"086c97c2-9984-49dd-86c6-eeabb810eec6","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-03T13:11:41+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T06:48:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 06:48:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9361371","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9361371","identity":"rs-9361371","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}