Comparison of Complication Rates Between Immediate and Delayed Breast Reconstruction Following Mastectomy for Breast Cancer

BACKGROUND: The optimal timing of breast reconstruction following mastectomy remains controversial. While immediate breast reconstruction (IBR) offers psychological benefits and potentially superior aesthetic outcomes, concerns persist regarding its association with higher complication rates compared with delayed breast reconstruction (DBR). This meta-analysis aims to comprehensively evaluate the comparative complication profiles between IBR and DBR across different reconstruction modalities. METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from January 2015 to December 2025. Studies comparing complication rates between IBR and DBR in breast cancer patients were included. Data were pooled using random-effects models, with subgroup analyses performed by reconstruction type (implant-based vs. autologous). Study quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Seven studies comprising 73,037 patients (52,851 IBR; 8162 DBR for stratified analyses) were included. For implant-based reconstruction, IBR was associated with significantly higher complication rates compared with DBR (OR: 2.10, 95% CI: 1.53-2.89, I²=77.5%). In contrast, autologous reconstruction showed no significant difference between IBR and DBR (OR: 1.03, 95% CI: 0.86-1.22, I²=51.1%). Sensitivity analyses confirmed the robustness of these findings. CONCLUSIONS: The timing of breast reconstruction significantly influences complication rates, with differential effects based on reconstruction type. Implant-based IBR demonstrates ∼2-fold higher odds of complications compared with DBR, while autologous reconstruction shows comparable outcomes regardless of timing. These findings should inform shared decision-making between surgeons and patients.