Current Practices and Evolving Trends in Implant-based Breast Reconstruction in China: A Nationwide Cross-sectional Survey.

Background: Implant-based breast reconstruction (IBBR) is widely used globally and in China, but regional disparities and concerns about complications persist. This nationwide survey evaluates current IBBR practices and trends. Methods: A cross-sectional survey was conducted in 215 hospitals in 2022, collecting data on surgical volume, reconstruction types, mesh usage, and complications. A total of 198 hospitals provided complete responses, with 122 offering IBBR. Results: IBBR hospitals had higher surgical volumes, greater bed capacity, more breast specialists, and higher reconstruction rates. In these hospitals, IBBR accounted for a median of 93.5% of reconstructions, with a median annual volume of 24.5 (interquartile range [IQR]: 9-59.3). High-volume hospitals (≥100 IBBR/y) performed 69.4% of cases. TiLOOP Bra was available in 76.2% of hospitals, with 45.9% using it in more than 50% of cases. Prepectoral reconstruction comprised a median of 30% of IBBR cases. Most IBBR procedures used a single mesh (median 95%, IQR: 60%-100%), whereas 2-mesh usage was rare. Direct-to-implant reconstruction with mesh was the most common immediate approach (54.1%), increasing from 23.2% in 2017. Radiation therapy (62.3%), capsular contracture (62.3%), and infection (61.5%) were the leading concerns. Estimated median complication rates were 5% (IQR: 0%-10%) for contracture, 3% (IQR: 1%-10%) for infection, and 2% (IQR: 0%-5%) for implant loss. Conclusions: IBBR adoption is increasing in China, particularly with mesh-assisted techniques such as TiLOOP Bra. However, disparities in access and concerns over complications highlight the need for standardized care and further research.