Rib Resection vs. Rib Preservation in Autologous Breast Reconstruction: An Outcome Analysis of 234 Patients

BACKGROUND: In autologous breast reconstruction, the internal mammary artery is the preferred recipient vessel. Although rib-resecting is usually performed, the rib-preserving technique has gained increasing attention in recent years without being scientifically evaluated. METHODS: In our retrospective study, we analyzed 234 autologous breast reconstructions performed between 2018 and 2023 at a single hospital, comparing 163 patients who underwent rib resection with 71 patients who received the rib-preserving technique. Intraoperative data, postoperative pain medication usage, and follow-up interventions over a minimum of one year were screened. RESULTS: Ischemia time was significantly shorter in the rib-resecting group (45:00 min, IQR 37:44-60:00) compared with the rib-sparing group (50:59 min, IQR 43:59-71:00; p = 0.006). However, the rib-sparing group had longer pedicle lengths (11, IQR 10-12 vs. 10, IQR 9.5-11 cm; p = 0.074) and larger arterial diameters (p = 0.084). Postoperatively, rib-resecting patients required longer opioid treatment (3, IQR 2-4.25 vs. 2.5, IQR 1.63-3 days; p = 0.019), reported greater pain on the first postoperative day (p = 0.049), and exhibited more blood loss and drainage volume (p = 0.033, p =