Current Trends in Revision Surgery After Breast Reconstruction in China: Insights from a Nationwide Cross-Sectional Survey

Abstract Introduction Revision surgery is an integral component of post-mastectomy breast reconstruction, aimed at enhancing breast aesthetics and improving patient satisfaction. While developed countries have established high rates of revision surgery, its implementation in China remains limited. We aimed to evaluate the current practices and challenges of revision surgery in Mainland China using a nationwide cross-sectional survey. Methods A nationwide questionnaire authorized by the Chinese Anti-Cancer Association and related committees was distributed to 215 hospitals in China performing over 200 annual breast cancer surgeries, with 198 hospitals completed the survey. Data on nipple-areola complex reconstruction (NAR), autologous fat grafting (AFG), and contralateral breast symmetry surgery were collected and analyzed. Results Of the 198 surveyed hospitals, 23.2% performed NAR, 17.2% conducted AFG, and 26.8% carried out contralateral breast symmetry surgery, with only 6.6% providing all three. (1) NAR: Both the time intervals between primary breast reconstruction and NAR and the diverse techniques of NAR were to note. The use of autologous or allogenic implants has proven to improve long-term nipple projection (median nipple shrinkage rate 5.5% vs 30%; P < 0.001), but its usage was still limited. (2) AFG: AFG has wide application in breast reconstruction, with the most common use remaining the correction of deformities after lumpectomy (28/34, 82.4%) or breast reconstruction after mastectomy (21/34, 61.8%). (3) Contralateral breast symmetry surgery: Contralateral breast symmetry surgery was widely accepted by patients, and a simultaneous procedure was more favored (median 80% vs 20%; P < 0.001). Conclusion The implementation of revision surgery in China remains insufficient and unevenly distributed. Targeted efforts to expand specialized training, especially in plastic surgery, improve resource allocation, and adopt advanced techniques are essential. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .