A Global Propensity Score–matched Analysis of 56,992 Nicotine-dependent Versus Nondependent Breast Reconstruction Cases

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.