{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T08:58:42Z","timestamp":1790585922022,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n The \u201crib\u2010sparing\u201d method of autologous breast reconstruction has gained popularity alongside the historically used \u201crib\u2010sacrificing\u201d technique. Literature has endorsed benefits of the \u201crib\u2010sparing\u201d technique, including reduced contour irregularities, postoperative morphine use, and operative time. However, higher rates of fat necrosis and thromboembolic complications have been reported with this method. This study aims to compare postoperative complications in those undergoing rib\u2010sparing and rib\u2010sacrificing free flap breast reconstruction using a large\u2010scale database.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective cohort study was conducted using the US Collaborative Network in TriNetX. Two cohorts were identified: those who underwent a free flap breast reconstruction (CPT 16634) and those who underwent a free flap breast reconstruction and a partial rib excision (CPT 21600). Propensity score matching for age and type of previous mastectomy was performed. Complications tabulated within 3\u2009months of reconstruction were fat necrosis, hematoma\/seroma, infection, dehiscence\/necrosis, and venous thromboembolism. Mastodynia and deformity\/disproportion within 8\u201318\u2009months and reconstruction within 6\u201310\u2009years of reconstruction were also tabulated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Propensity score matching yielded 992 subjects with a mean age of 50\u2009\u00b1\u20099.7 in each group. No difference was found between the rib\u2010sparing and rib\u2010sacrificing cohorts within the perioperative window for the included complications: hematoma\/seroma (8.1% vs. 8.1%;\n p<\/jats:italic>\n \u2009=\u20091.00), infection (\n p<\/jats:italic>\n \u2009=\u200914.4% vs. 12.3%; 0.166), dehiscence\/necrosis (9.2% vs. 7.6%;\n p<\/jats:italic>\n \u2009=\u20090.195), and VTE (5.1% vs. 5.3%;\n p<\/jats:italic>\n \u2009=\u20090.857). The rib sacrificing cohort were at 1.28 times increase risk for experiencing fat necrosis (12.9% vs. 10.1%; 95% CI: 1.00\u20131.64;\n p<\/jats:italic>\n \u2009=\u20090.049). No difference was found in incidence of mastodynia (4.8% vs. 3.5%;\n p<\/jats:italic>\n \u2009=\u20090.145) or dehiscence\/necrosis (24.8% vs. 26.8%;\n p<\/jats:italic>\n \u2009=\u20090.305) within 8\u201318\u2009months. Subjects in the rib\u2010sacrificing cohort were found to be at 1.21 (35.9% vs. 32.2%; 95% CI: 1.08\u20131.35;\n p<\/jats:italic>\n \u2009<\u20090.001) times increased risk to undergo a revision within 6\u201310\u2009years following initial reconstruction.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Those who underwent rib\u2010sacrificing reconstruction have a mild increased risk of experiencing fat necrosis and a revision in the 3\u2009months and 6\u201310\u2009years following initial reconstruction, respectively. Surgeons should consider the nuanced risks and benefits of both techniques and prioritize patient\u2010centered decision\u2010making.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/micr.70270","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:37:56Z","timestamp":1788424676000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Postoperative Outcomes of Rib\u2010Sparing Versus Rib\u2010Sacrificing in Free Flap Breast Reconstruction Using the\n US<\/scp>\n Collaborative Network in\n TriNetX<\/scp>"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8816-6207","authenticated-orcid":false,"given":"Chloe J.","family":"Cottone","sequence":"first","affiliation":[{"name":"Department of Surgery Jacobs School Medicine and Biomedical Sciences at the University at Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Kozlowski","sequence":"additional","affiliation":[{"name":"Department of Surgery Jacobs School Medicine and Biomedical Sciences at the University at Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa D.","family":"Reese","sequence":"additional","affiliation":[{"name":"Division of Plastic and Cosmetic Surgery, Department of Surgery Eastern Virginia Medical School Norfolk Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6620-8099","authenticated-orcid":false,"given":"Erinn E.","family":"Mangona","sequence":"additional","affiliation":[{"name":"Department of Surgery Jacobs School Medicine and Biomedical Sciences at the University at Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua C.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Surgery Jacobs School Medicine and Biomedical Sciences at the University at Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan D.","family":"Frey","sequence":"additional","affiliation":[{"name":"Department of Surgery Jacobs School Medicine and Biomedical Sciences at the University at Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"American Society of Plastic Surgeons. n.d.\u201cAmerican Society of Plastic Surgeons Reveals 2022's Most Sought\u2010After Procedures.\u201dhttps:\/\/www.plasticsurgery.org\/news\/press\u2010releases\/american\u2010society\u2010of\u2010plastic\u2010surgeons\u2010reveals\u20102022s\u2010most\u2010sought\u2010after\u2010procedures."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30963"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2010.03.003"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31827c6d38"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2010.08.002"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e3180698385"},{"key":"e_1_2_10_8_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core 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Zhi"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2019.08.08"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70270","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70270","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70270","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T08:34:11Z","timestamp":1790584451000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/micr.70270"],"URL":"https:\/\/doi.org\/10.1002\/micr.70270","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2025-03-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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