Abstract:Background and Aims Implant-based breast reconstruction is one of the most common reconstructive approaches after mastectomy for breast cancer. However, the incidence of postoperative complications remains significant, and the associated risk factors have not been fully elucidated. This study aimed to analyze the incidence of surgical complications following implant-based breast reconstruction in patients undergoing mastectomy at our center and to identify potential risk factors.Methods A retrospective analysis was conducted on patients who underwent mastectomy and implant-based breast reconstruction at Sun Yat-sen Memorial Hospital between May 2004 and August 2022. Patients were grouped according to the presence or absence of postoperative surgical complications, and multivariate Logistic regression was used to identify independent risk factors.Results A total of 545 patients with 602 reconstructed breasts were included. Surgical complications occurred in 13.6% (82/602) of the cases, including infection, wound dehiscence/poor healing, flap or nipple-areola necrosis, and implant leakage/rupture. Multivariate analysis revealed that nipple-areola complex resection (OR=1.934, 95% CI=1.056-3.542, P=0.033), postoperative radiotherapy (OR=2.483, 95% CI=1.527-4.036, P<0.001), implant volume ≥300 mL (OR=1.663, 95% CI=1.025-2.696, P=0.039), and surgeon experience with fewer than 10 cases (OR=1.804, 95% CI=1.092-2.979, P=0.021) were all independent risk factors for complications.Conclusion NAC resection, radiotherapy, large implant volume, and limited surgical experience are important independent risk factors for postoperative surgical complications following implant-based breast reconstruction. Thorough preoperative evaluation and appropriate surgical planning are essential to minimize risks.