Complications in Post-Oncological Reconstructive Breast Surgery: Clinical and Cardiovascular Risk Factors

well documented, a gap remains in the literature regarding the combined effect of systemic comorbidities and radiotherapy on implant-based breast reconstruction. Objectives: To characterize the clinical distribution of complications necessitating surgical revision over a 26-year period, and to evaluate the predictive role of cardiovascular risk factors, smoking habits, exploratory hematological biomarkers, and postmastectomy radiotherapy. Materials and Methods: Retrospective, single-center study conducted at the Azienda Ospedaliero-Universitaria di Modena. Seventy-seven patients undergoing implant-based reconstruction with subsequent device replacement/removal were included, stratified by radiotherapy status (17 RT, 60 non-RT). Fisher's exact test, Mann-Whitney U test, Kaplan-Meier curves with log-rank test, and multivariable regression models were employed. Results: Implant rupture (39.0%) and capsular contracture (35.1%) were the predominant causes of replacement, with a median time to complication of 108 months. Radiotherapy emerged as an independent, significant risk factor across all multivariable models: shorter time to complication (p=0.021), a different distribution of complication type (p=0.046), and a higher risk of complications following replacement (p=0.038, OR 3.50). Smoking showed a significant univariate association with time to complication (p=0.034), attenuated in adjusted models. Lower preoperative hemoglobin, red blood cell count, and hematocrit were associated with a shorter time to complication, a pattern not previously described in this context. NLR and PLR showed no predictive value. Hypertension, apparently associated with a longer time to complication, lost significance after adjustment for age, indicating that the univariate association was confounded by age rather than reflecting a true independent effect. Conclusions: Postmastectomy radiotherapy is confirmed as the most robust risk factor for implant-based reconstruction failure. Smoking remains a relevant modifiable factor. The association with preoperative anemia represents a potential novel indicator warranting further investigation in future prospective studies.