Shifting Practice Patterns in Implant-based Breast Reconstruction in China: Insights From a 13-year Large-scale Retrospective Cohort

Background: Implant-based breast reconstruction (IBBR) has become the leading method for postmastectomy reconstruction worldwide. In China, growing patient demand has driven increased use of IBBR, but national trends in techniques and outcomes remain underreported. This study aimed to evaluate the evolution of IBBR practices and associated outcomes during a 13-year period at China’s largest breast cancer center. Methods: We retrospectively analyzed 6088 patients who underwent breast reconstruction at Fudan University Shanghai Cancer Center from 2010 to 2023. We examined trends in surgical timing, reconstruction type (direct-to-implant DTI versus 2-stage tissue expander TE), mastectomy type, implant placement (prepectoral versus subpectoral), TiLOOP Bra use, postmastectomy radiotherapy, and unplanned reoperations. Logistic regression identified factors associated with DTI selection and reoperation risk. Results: The proportion of patients undergoing mastectomy receiving reconstruction rose from 5.3% in 2010 to 16.7% in 2023. IBBR became the predominant method after 2015, comprising 70%–80% of reconstructions since 2017. DTI surpassed TE in 2023, accounting for 73.4% of implant cases. DTI reconstruction was independently associated with nipple-sparing mastectomy, TiLOOP Bra use, and prepectoral placement. TiLOOP use significantly reduced reoperation risk (odds ratio = 0.63, P = 0.03), whereas TE use was associated with an increased risk (odds ratio = 1.58, P = 0.039). Conclusions: IBBR in China has rapidly evolved, with DTI and TiLOOP Bra use driving improved surgical outcomes. These findings support the growing role of surgical innovation, mesh support, and individualized planning in modern breast reconstruction.