Thirteen Years of Reconstructive Breast Surgery in a Korean Tertiary Practice: Procedure Spectrum, Shifting Practice, and Modality Selection in 2216 Patients

Background and Objectives: Reconstructive breast surgery covers a far wider range of operations than the implant-versus-autologous dichotomy: oncoplastic techniques, several pedicled flap designs, and chest wall coverage of defects resisting primary closure are rarely reported together. We described the complete reconstructive spectrum of a single tertiary center over thirteen years and asked whether the reconstructive choice carries prognostic information. Materials and Methods: All reconstructive procedures performed by the breast reconstruction service of a Korean tertiary hospital between December 2012 and July 2026 were reviewed retrospectively. Free-text operative descriptions were mapped onto a 26-category classification, and each patient received a primary technique from her index operation, separated by reconstructive intent: restoration of breast form or coverage of a defect after wide resection. Mortality was ascertained from institutional records; termination of National Health Insurance eligibility was examined separately as a candidate surrogate, with the last institutional attendance retrieved for every patient so flagged. Associations with recorded mortality were assessed by logistic regression. Results: In total, 2216 patients underwent 2523 procedures. The index operation was autologous reconstruction in 907 patients (40.9%), oncoplastic breast-conserving surgery in 623 (28.1%), implant-based reconstruction in 564 (25.5%), and chest wall reconstruction in 14 (0.6%). Autologous reconstruction fell from 67 of 114 index procedures in 2014 to 15 of 160 in 2026, whereas implant-based reconstruction rose from four to 70. Recorded mortality was 1.8% overall and ranged from none after several oncoplastic techniques to 28.6% after chest wall reconstruction. Patients whose eligibility had lapsed resembled survivors rather than the deceased; all 41 had attended in person after reconstruction, at a median of 4.3 years. Conclusions: The reconstructive operation summarizes the oncological situation rather than determining survival independently. Chest wall reconstruction merits reporting apart from breast reconstruction, and lapsed insurance eligibility performed poorly as a surrogate for mortality.