Short-term Quality of Life after Autologous Compared to Alloplastic Breast Reconstruction: A Prospective Study

BACKGROUND: The aim of this prospective multi-center study was to evaluate whether autologous breast reconstruction (BR) leads to lower short-term Quality of Life (QoL) compared to alloplastic BR, due the more physically demanding surgery and increased risk of severe complications of autologous BR.

METHODS: Changes in QoL following BR were measured in this prospective multi-center study using the Breast-Q questionnaire which was administered preoperatively, and at six weeks and six months postoperatively. Characteristics and complications, classified according to Clavien-Dindo (CD), were compared between alloplastic and autologous groups. Profile plots and generalized Linear regression models were constructed to analyze the Breast-Q subscales over time for both BR groups.

RESULTS: Preoperatively, women undergoing autologous BR scored lower on all Breast-Q scales compared to women undergoing alloplastic BR, regardless whether they underwent immediate or delayed BR. Women undergoing autologous BR scored higher at six weeks and six months postoperative on "satisfaction with breasts" (p=0.001), "psychosocial well-being" (p=0.024) and "sexual well-being" (p=0.007). Postoperative "physical well-being: chest" was similar between both groups (p=0.533). CD grade ≥III complications occurred more often among women in the autologous group (27% versus 12%, p=0.042). Complications were not associated with worse Breast-Q scores on any of the subscales.

CONCLUSION: In contrast to our expectations and despite the higher incidence of severe complications and lower preoperative breast satisfaction and QoL scores, women undergoing autologous BR have higher levels of breast satisfaction, and psychosocial and sexual well-being, both at six weeks and six months after BR compared to women undergoing alloplastic BR.