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Peer-reviewedCC BY-NC-NDBlood vessels, thrombosis & hemostasis

Thromboembolic and hemorrhagic risks after mastectomy with vs without direct-to-implant reconstruction.

  • Jonathan Mokhtar1,2
  • John Y Ha3,4
  • Jewel Haddad1
  • Curtis L Cetrulo2
  • David M Smadja5,6
  • Alexandre G Lellouch2,5,6
6 affiliations
  1. 1College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates.
  2. 2Division of Plastic and Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
  3. 3School of Medicine, Case Western Reserve University, Cleveland, OH.
  4. 4Department of Plastic Surgery, Institute of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, OH.
  5. 5Team Endotheliopathy and Hemostasis Disorders, Paris Cardiovascular Research Center, Université Paris Cité, INSERM, Paris, France.
  6. 6Hematology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
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Abstract

Immediate direct-to-implant (DTI) breast reconstruction after mastectomy provides aesthetic and logistic advantages, including single-stage restoration and avoidance of tissue expansion. However, concerns persist that increased operative duration and procedural complexity may elevate thromboembolic and hemorrhagic risk. This study compared 90-day postoperative complication rates between mastectomy and mastectomy+DTI reconstruction. A multicenter cohort study was conducted using the TriNetX Research Network. Adult female patients with breast cancer undergoing mastectomy with or without immediate DTI between 2010 and 2025 were included; autologous and staged reconstructions were excluded. Propensity score matching (1:1) balanced demographics, body mass index, comorbidities, oncologic history, and preoperative medications. Outcomes included hematoma, acute deep vein thrombosis (DVT), and pulmonary embolism (PE). After matching, 11 538 patients (5769 pairs) were analyzed. Mastectomy+DTI was associated with lower hematoma rates (54 patients [0.94%] vs 81 [1.40%]; risk ratio [RR], 0.675; 95% confidence interval [CI], 0.48-0.95; P = .024) and fewer DVT events (22 patients [0.38%] vs 48 [0.83%]; RR, 0.458; 95% CI, 0.28-0.76; P = .002). PE occurred in 17 patients (0.29%) vs 29 (0.50%) (RR, 0.586; 95% CI, 0.32-1.07; P = .076). Immediate DTI after mastectomy was associated with lower short-term rates of hematoma and DVT, with a nonsignificant trend toward lower PE rates. These findings suggest that immediate DTI was not associated with increased short-term thromboembolic or hemorrhagic morbidity in this matched cohort. Given the limitations of coding-based observational data and potential residual confounding, prospective multicenter studies incorporating granular perioperative variables are required to confirm these associations and refine risk-stratified decision-making in reconstructive care.

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Cite

BibTeXRIS
BibTeX
@article{mokhtar2026thromboembolic,
  title = {{Thromboembolic and hemorrhagic risks after mastectomy with vs without direct-to-implant reconstruction.}},
  author = {Jonathan Mokhtar and John Y Ha and Jewel Haddad and Curtis L Cetrulo and David M Smadja and Alexandre G Lellouch},
  journal = {Blood vessels, thrombosis \& hemostasis},
  year = {2026},
  month = aug,
  doi = {10.1016/j.bvth.2026.100208},
  url = {https://europepmc.org/article/MED/42904160},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Thromboembolic and hemorrhagic risks after mastectomy with vs without direct-to-implant reconstruction.
AU  - Jonathan Mokhtar
AU  - John Y Ha
AU  - Jewel Haddad
AU  - Curtis L Cetrulo
AU  - David M Smadja
AU  - Alexandre G Lellouch
PY  - 2026
DA  - 2026/08/28
JO  - Blood vessels, thrombosis & hemostasis
DO  - 10.1016/j.bvth.2026.100208
UR  - https://europepmc.org/article/MED/42904160
AB  - Immediate direct-to-implant (DTI) breast reconstruction after mastectomy provides aesthetic and logistic advantages, including single-stage restoration and avoidance of tissue expansion. However, concerns persist that increased operative duration and procedural complexity may elevate thromboembolic and hemorrhagic risk. This study compared 90-day postoperative complication rates between mastectomy and mastectomy+DTI reconstruction. A multicenter cohort study was conducted using the TriNetX Research Network. Adult female patients with breast cancer undergoing mastectomy with or without immediate DTI between 2010 and 2025 were included; autologous and staged reconstructions were excluded. Propensity score matching (1:1) balanced demographics, body mass index, comorbidities, oncologic history, and preoperative medications. Outcomes included hematoma, acute deep vein thrombosis (DVT), and pulmonary embolism (PE). After matching, 11 538 patients (5769 pairs) were analyzed. Mastectomy+DTI was associated with lower hematoma rates (54 patients [0.94%] vs 81 [1.40%]; risk ratio [RR], 0.675; 95% confidence interval [CI], 0.48-0.95; P = .024) and fewer DVT events (22 patients [0.38%] vs 48 [0.83%]; RR, 0.458; 95% CI, 0.28-0.76; P = .002). PE occurred in 17 patients (0.29%) vs 29 (0.50%) (RR, 0.586; 95% CI, 0.32-1.07; P = .076). Immediate DTI after mastectomy was associated with lower short-term rates of hematoma and DVT, with a nonsignificant trend toward lower PE rates. These findings suggest that immediate DTI was not associated with increased short-term thromboembolic or hemorrhagic morbidity in this matched cohort. Given the limitations of coding-based observational data and potential residual confounding, prospective multicenter studies incorporating granular perioperative variables are required to confirm these associations and refine risk-stratified decision-making in reconstructive care.
SN  - 2950-3272
ER  -