Impact of Surgical Delay on Two-Stage Breast Reconstruction During the COVID-19 Pandemic: A Retrospective Analysis

<b>Background:</b> The COVID-19 pandemic caused unprecedented delays in elective surgery, including breast reconstruction, prolonging expander retention beyond recommended timelines. <b>Methods:</b> We retrospectively compared patients who underwent two-stage expander-to-implant reconstruction before the pandemic (2011-2020) and during the pandemic (2020-2022). Clinical outcomes and patient-reported experiences were analyzed, and multivariate regression was used to adjust for confounders. <b>Results:</b> Expander retention was significantly longer in the pandemic cohort (481 vs. 280 days). Capsular contracture around the expander was markedly increased, with pandemic group assignment and prolonged expander retention emerging as independent predictors in multivariate analysis, while overall complication rates were unaffected. Patient-reported outcomes showed more functional limitations but paradoxically higher satisfaction with the definitive implant. <b>Conclusions:</b> Surgical delay selectively increased the risk of expander contracture without raising overall morbidity. Patient-reported findings highlight the dual impact of delay, with both greater burden and a potential "relief effect".