Thirteen Years of Reconstructive Breast Surgery in a Korean Tertiary Practice: Procedure Spectrum, Shifting Practice, and Modality Selection in 2216 Patients

Background and Objectives: Reconstructive breast surgery covers a far wider range of operations than the implant-versus-autologous dichotomy: oncoplastic techniques, several pedicled flap designs, and chest wall coverage of defects resisting primary closure are rarely reported together. We described the complete reconstructive spectrum of a single tertiary center over thirteen years and asked whether the reconstructive choice carries prognostic information. Materials and Methods: All reconstructive procedures performed by the breast reconstruction service of a Korean tertiary hospital between December 2012 and July 2026 were reviewed retrospectively. Free-text operative descriptions were mapped onto a 26-category classification, and each patient received a primary technique from her index operation, separated by reconstructive intent: restoration of breast form or coverage of a defect after wide resection. Mortality was ascertained from institutional records; termination of National Health Insurance eligibility was examined separately as a candidate surrogate, with the last institutional attendance retrieved for every patient so flagged. Associations with recorded mortality were assessed by logistic regression.