Post-Operative Complications Do Not Influence Time to Adjuvant Treatment in Breast Cancer Patients Undergoing Implant-Based Reconstructions: Pre-Pectoral Versus Sub-Pectoral

Background: Immediate breast reconstruction after mastectomy has progressively shifted toward less invasive approaches. The pre-pectoral approach, avoiding muscle dissection, may reduce post-operative pain, surgical trauma, and recovery time. However, concerns regarding surgical complications and their potential impact on the timing of adjuvant treatments still persist. Methods: A retrospective monocentric study was conducted, including all patients who underwent mastectomy with implant-based breast reconstruction at the Breast Unit of Policlinico Tor Vergata in Rome between January 2014 and March 2024. Patients were classified according to the reconstructive technique as either pre-pectoral or sub-pectoral. Demographic, oncologic, and surgical data were collected and analyzed, with a particular focus on post-operative complications and the timing of adjuvant treatment initiation. Results: Of 622 patients, 366 (58.9%) underwent sub-pectoral reconstruction and 235 (37.7%) pre-pectoral. Overall, the complication rates were comparable between the two reconstructions (23.8% vs. 20.2%, p = 0.310). Delayed wound healing was higher in the pre-pectoral group (9.0% vs. 4.3%, p = 0.035), whereas post-operative bleeding occurred more often in sub-pectoral cases (4.9% vs. 0.4%, p = 0.057). Operative time was significantly shorter in the pre-pectoral group (p < 0.001). Multivariate analysis identified skin-reducing mastectomy (OR 2.11), smoking (OR 2.89), and diabetes mellitus (OR 3.06) as predictors of delayed adjuvant therapy, whereas the reconstruction technique was not associated with delays.