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The association between resident involvement and surgical morbidity in immediate breast reconstruction is not fully elucidated, and prior studies have had conflicting results. The authors studied whether resident involvement in immediate breast reconstruction is associated with the most important short-term outcomes: increased 30-day surgical morbidity, readmission and reoperation rates, operative time, and length of stay.Patients undergoing immediate breast reconstruction were identified in the 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files. The authors used simple and multivariable regression to assess surgical complications and secondary outcomes, stratifying by training level and reconstruction type.A total of 24,191 patients underwent immediate breast reconstruction; 17,840 had resident involvement. Thirty-day surgical morbidity was observed in 5.25 percent (95 percent CI, 4.92 to 5.58 percent) of cases with resident involvement and 5.12 percent (95 percent CI, 4.59 to 5.58 percent) of cases without, with no evidence of association between resident involvement and 30-day morbidity (adjusted OR, 0.97; 95 percent CI, 0.85 to 1.11; p = 0.652). Resident involvement was not associated with an increase in complications in implant-based or mixed types of reconstruction, and was associated with lower odds of complications in autologous reconstructions (OR, 0.70; 95 percent CI, 0.53 to 0.91; p = 0.008). It was associated with longer operative times (an average of 24 additional minutes for implant-based and 54 additional minutes for autologous reconstructions; p < 0.001); this was balanced by a shorter length-of-stay for patients undergoing implant-based reconstruction (adjusted OR, 0.88; 95 percent CI, 0.79 to 0.96; p = 0.010).In immediate breast reconstruction patients, resident involvement was not associated with increased postoperative surgical morbidity or complications, although operative time was significantly increased with resident involvement across all levels of training.Therapeutic, III.