Breast-related and body-related quality of life following autologous breast reconstruction is superior to implant-based breast reconstruction - A long-term follow-up study

Abstract

Introduction: The better survival rates after breast cancer allow for setting of long-term goals, such as Quality of Life (QoL) and aesthetic outcomes following breast reconstruction. Studies find a higher breast-related QoL and greater satisfaction with breasts following autologous breast reconstruction (ABR) compared to implant-based breast reconstruction (IBR). However, aesthetic results from donor sites can influence body image. This concern is little addressed in the literature. Therefore, the aim of this study was to compare the long-term breast-related and body-related QoL of women who underwent ABR to women who underwent IBR. Material and methods: A multicenter, cross-sectional survey was conducted between November and December 2020 among women who underwent postmastectomy breast reconstruction between January 2015 and December 2018. A general questionnaire, the BREAST-Q, and the BODY-Q were used to collect data. Multivariable linear regression was performed to adjust differences in Q-scores for potential confounders. Results: In total, 336 patients were included (112 IBR, 224 ABR). Autologous reconstruction resulted in significantly higher mean scores in all subdomains of the BREAST-Q. On the BODY-Q, IBR scored significantly higher on scars, while ABR scored moderately to significantly higher on all other scales. Despite a lower mean score on Hips & outer thighs in women with Lateral Thigh Perforator (LTP) flap reconstruction, no negative influence on body image was found in these women. Conclusions: Long-term breast-related and body-related outcomes of ABR are superior to IBR. Donor site aesthetic does not adversely affect body image in women who underwent free flap breast reconstruction.

Autologous vs. implant-based breast reconstruction after skin- and nipple-sparing mastectomy—A deeper insight considering surgical and patient-reported outcomes

“…Consistent with previous findings, the Breast-Q showed the ABR patients to be more satisfied with the breast and overall outcome and to have a superior psychosocial and physical wellbeing (chest); however, only the differences in “satisfaction with breast” reached statistical significance ( 8 , 10 , 17 ). Statistical significance might have been achieved in the other subscales with a bigger sample size in the ABR group.…”

“…Statistical significance might have been achieved in the other subscales with a bigger sample size in the ABR group. Nevertheless, mean scores were comparable to the numbers stated by Misere et al (Breast: ABR 68.3, IBR 55.5; Outcome: ABR: 70.9, IBR: 60.0) and Weichman et al (Breast: ABR 73.8, IBR 63.7; Outcome: 76.0, IBR 73.1) ( 10 , 17 ). In contrast, concerning the health-related QoL (EORTC QLQ-C30 and BR23), none of the procedure showed to be superior.…”

“…Previous studies comparing ABR to IBR concentrated mostly on “patient-reported satisfaction with breast” using the Breast-Q ( 8 , 10 , 11 , 17 ). Only a few studies compared the aesthetic outcome ( 18 – 20 ) as well as the quality of breast and NAC sensitivity ( 3 , 21 , 22 ) with the majority of them displaying a small patient collective ( 23 ).…”

“…Thanks to the development of the Breast-Q, patient-reported outcomes in breast reconstruction have widely been explored, while the health-related quality of life (HRQoL) and symptoms of depression have been neglected (8,9). Studies giving a comprehensive overview of further clinical and surgical outcome parameters such as complication rates, aesthetic outcome, and breast sensibility of both procedures are lacking (8,(10)(11)(12). Furthermore, most studies do not include a homogenous patient collective with regard to the type of mastectomy (6,10), which makes the interpretation of the study results difficult (8).…”

Donor-Site Morbidity and Quality of Life after Autologous Breast Reconstruction with PAP versus TMG Flap

“…Autologous breast reconstruction is still the primary method used for permanent restoration of the breast mound following any type of mastectomy due to its natural aesthetic result and high patient satisfaction [ 6 ]. Several studies using patient-reported outcome measures found a higher quality of life and greater satisfaction after autologous breast reconstruction compared to implant-based techniques [ 7 , 8 , 9 ]. Abdominal-based flaps, more precisely the deep inferior epigastric perforator (DIEP) flap, is considered the gold standard for breast reconstruction [ 10 , 11 , 12 ].…”