Plastic and reconstructive surgery. Global open · 2026
A Global Propensity Score-matched Analysis of 56,992 Nicotine-dependent Versus Nondependent Breast Reconstruction Cases.
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Tanas Yousef, Harris Peyton, Chen Stephen, Heckel Brooke, Nguyen Philong, Wang Joshua, Gasper Grace, Swed Sarya, Spiegel Aldona
Аннотация
BACKGROUND: Nicotine dependence is known to cause impaired wound healing and increase risk of surgical complications; nonetheless, the literature lacks evidence regarding the risks of capsular contracture and other implant-related complications.
METHODS: A retrospective cohort study was conducted using data from the TriNetX global health research network. Patients undergoing breast reconstruction were categorized into 2 cohorts: those with nicotine dependence documented within 6 months before surgery and those without nicotine use.
RESULTS: Propensity score matching was performed, resulting in balanced cohorts of 28,496 patients each. The nicotine dependence cohort had a higher incidence of seroma formation (risk ratio [RR] = 1.224 [1.177-1.274]; P < 0.0001), hematoma (RR = 1.218 [1.170-1.268]; P < 0.0001), dehiscence (RR = 1.460 [1.362-1.564]; P < 0.0001), capsular contracture (RR = 1.167 [1.132-1.203]; P < 0.0001), implant-related mechanical complications (RR = 1.327 [1.245-1.414]; P < 0.0001), revision surgery (RR = 1.099 [1.074-1.125]; P < 0.0001), breast fat necrosis (RR = 1.251 [1.172-1.335]; P < 0.0001), and infection (RR = 1.340 [1.281-1.401]; P < 0.0001). There was no statistically significant difference (P > 0.05) between the 2 cohorts regarding postmastectomy lymphedema syndrome and flap loss or failure.
CONCLUSIONS: Nicotine dependence increases the risk of many surgical complications in breast reconstruction, consistent with previous studies. Interestingly, it also increases the risk of capsular contracture and other implant-related mechanical complications (malposition/displacement, rupture). These results emphasize the need for smoking and nicotine cessation before breast reconstruction.
METHODS: A retrospective cohort study was conducted using data from the TriNetX global health research network. Patients undergoing breast reconstruction were categorized into 2 cohorts: those with nicotine dependence documented within 6 months before surgery and those without nicotine use.
RESULTS: Propensity score matching was performed, resulting in balanced cohorts of 28,496 patients each. The nicotine dependence cohort had a higher incidence of seroma formation (risk ratio [RR] = 1.224 [1.177-1.274]; P < 0.0001), hematoma (RR = 1.218 [1.170-1.268]; P < 0.0001), dehiscence (RR = 1.460 [1.362-1.564]; P < 0.0001), capsular contracture (RR = 1.167 [1.132-1.203]; P < 0.0001), implant-related mechanical complications (RR = 1.327 [1.245-1.414]; P < 0.0001), revision surgery (RR = 1.099 [1.074-1.125]; P < 0.0001), breast fat necrosis (RR = 1.251 [1.172-1.335]; P < 0.0001), and infection (RR = 1.340 [1.281-1.401]; P < 0.0001). There was no statistically significant difference (P > 0.05) between the 2 cohorts regarding postmastectomy lymphedema syndrome and flap loss or failure.
CONCLUSIONS: Nicotine dependence increases the risk of many surgical complications in breast reconstruction, consistent with previous studies. Interestingly, it also increases the risk of capsular contracture and other implant-related mechanical complications (malposition/displacement, rupture). These results emphasize the need for smoking and nicotine cessation before breast reconstruction.