Technique-Driven and Patient-Specific Variations in Complications of Mastectomy with Immediate Breast Reconstruction: An Evidence-Based Review

Mastectomy with immediate breast reconstruction (IBR) has become increasingly common, driven by advances in mastectomy techniques and the growing number of autologous, implant-based, and hybrid reconstructive options. The expansion of reconstructive strategies has introduced greater complexity in surgical planning and outcomes. Postoperative outcomes are influenced not only by mastectomy-related complications but also by complications specific to each reconstructive technique. Consequently, each combination of mastectomy and reconstructive modality carries unique benefits, limitations, and complication profiles that must be evaluated in the context of patient-specific factors, such as comorbidities, oncologic treatment, and reconstructive goals. This narrative review aims to characterize complication profiles associated with mastectomy and IBR to support improved perioperative management and individualized surgical care. To enhance clinical utility, this review includes representative clinical images that demonstrate variability in complication presentation across surgical approaches and patient contexts. This review presents a framework for understanding the factors that influence patient candidacy and outcomes in the setting of mastectomy with IBR, thereby supporting improved risk stratification and tailored treatment algorithms.