Association of sociodemographic and oncological features with decision on implant‐based versus autologous immediate postmastectomy breast reconstruction in Chinese patients

BACKGROUND AND OBJECTIVES: Immediate postmastectomy breast reconstruction (IPBR) has gained wide popularity in China. We sought to clarify the prevalence and predictors of implant-based vs autologous IPBR among Chinese patients. METHODS: A retrospective cohort study was performed using a prospectively maintained database. Women who underwent IPBR during 2001-2017 were included. The modality-specific trends were deciphered by curve fitting analysis. The association of sociodemographic and oncological features with the decision for implant-based vs autologous IPBR was investigated using multivariate logistic regression and structural equation modeling. RESULTS: Among 905 patients included in the study, 479 underwent implant-based IPBR and 426 underwent autologous procedures. The implant/autologous ratio has increased exponentially over time. Multivariate analysis demonstrated that unmarried patients with BMI ≤ 24 kg/m2 , earlier clinical tumor stage, and preoperative pathological diagnosis of noninvasive lesion are more likely to choose implant-based IPBR compared to autologous procedures. The indirect effects of age, mastectomy type, and neoadjuvant chemotherapy were further demonstrated by the structural equations. CONCLUSIONS: The sociodemographic and oncological features are directly or indirectly associated with the decision on type of IPBR. The findings may facilitate both patients and physicians to make a high-quality decision by holistic evaluation of the sociodemographic and oncological features.