Evolving Trends in Postmastectomy Breast Reconstruction With Autologous Tissues: A Large-Scale, 24-Year Retrospective Study in China.

Background: Autologous breast reconstruction (ABR) significantly improves quality of life following mastectomy. However, ABR has traditionally been underutilized compared to implant-based breast reconstruction (IBBR), partly due to its technical complexity, longer operative time, and relatively limited reimbursement. This study aimed to evaluate the patterns and evolving trends of ABR in China.

Methods: Annual trends in breast reconstruction at Fudan University Shanghai Cancer Center (FUSCC) from 2000 to 2023 were retrospectively analyzed. Data included patient demographics, reconstruction timing, flap types, adjuvant radiotherapy status, and reoperations due to complications. Temporal trends were assessed using linear regression analysis.

Results: Among 6,174 unilateral breast reconstruction cases, 2,123 (34.39%) involved ABR. Latissimus dorsi flaps (LDF) were the most commonly used technique overall (59.87%, n = 1,271), while the use of deep inferior epigastric perforator (DIEP) flaps increased markedly over time. By 2023, DIEP flaps accounted for 56.46% of all ABR procedures, becoming the predominant modality. Their rise was particularly notable in delayed and immediate-delayed reconstructions, as well as in salvage ABR following implant failure. Among patients receiving adjuvant radiotherapy, the preference for DIEP flaps also increased significantly. Both LDF and DIEP flaps demonstrated low reoperation rates, highlighting their safety and clinical reliability.

Conclusions: Autologous breast reconstruction in China is shifting toward increased utilization of DIEP flaps, particularly in delayed, immediate-delayed, and implant-salvage settings, as well as among patients undergoing radiotherapy. These findings support DIEP as a preferred flap type in modern reconstructive practice.