Background: Direct-to-implant breast reconstruction is the most common method for immediate breast restoration after mastectomies performed with prophylactic or curative indications. This approach significantly enhances patients’ quality of life without adversely affecting oncological outcomes. However, it remains unclear whether mastectomy with direct-to-implant breast reconstruction (M-DTI) is an optimal option for patients who refuse blood transfusions for religious reasons (e.g., Jehovah’s Witnesses) or other personal beliefs. Methods: We retrospectively reviewed 490 patients who underwent either mastectomy alone (MA) or M-DTI between January 2021 and June 2023. We analyzed patient characteristics, operative details, and rates of bleeding complications. Results: MA was performed on 220 patients, while mastectomy with immediate breast reconstruction was conducted on 270 patients. Overall, bleeding complications—including those requiring reoperation and/or blood transfusion—occurred in 21 patients. In the MA group, bleeding complications occurred in 2.4% of patients, compared to 1.8% in the M-DTI group (p= 0.249). The risk of severe bleeding was unrelated to age, diagnosis, or type of procedure. Conclusions: The findings of this study suggest that immediate breast reconstruction does not increase the risk of bleeding in patients undergoing mastectomy. Therefore, it should also be considered a viable option for patients requiring bloodless medicine.
背景：直接植入式乳房重建是预防性或治疗性乳房切除术后即刻乳房修复的最常用方法。该方法在不影响肿瘤学预后的前提下显著提升了患者的生活质量。然而，对于因宗教信仰（如耶和华见证人）或其他个人原因拒绝输血的患者，乳房切除联合直接植入式重建术是否仍为理想选择尚不明确。方法：我们回顾性分析了2021年1月至2023年6月期间接受单纯乳房切除术或联合重建术的490例患者，系统评估了患者特征、手术细节及出血并发症发生率。结果：220例患者接受单纯乳房切除术，270例接受联合重建术。总体出血并发症（包括需再次手术和/或输血者）发生21例。单纯切除组出血发生率为2.4%，联合重建组为1.8%（p=0.249）。严重出血风险与年龄、诊断类型及手术方式无显著相关性。结论：本研究表明即刻乳房重建不会增加乳房切除术患者的出血风险，因此对于需要实施无血医疗的患者而言，该术式同样应被视为可行选择。
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