Autologous versus Implant-Based Breast Reconstruction: Quality of Life Outcomes — A Narrative Review

Abstract

Introduction. Breast reconstruction after mastectomy represents an important component of breast cancer treatment, modifying not only aesthetic outcomes as well as quality of life, body image, and psychosocial functioning. The most commonly used methods include reconstruction with autologous tissue and reconstruction with artificial materials, mainly implants; however, the optimal reconstructive technique remains a matter of debate.

Aim. The aim of this review was to analyze and compare the quality of life and patient satisfaction after autologous and implant-based breast reconstruction, using available clinical studies, cohort studies, and meta-analyses.

Methods. A systematic literature review was performed using publications that used specific types of questionnaires, which can serve as objective scales for assessing quality of life after different types of breast reconstruction. Among these scales, the following can be mentioned: BREAST-Q, BODY-Q, SF-36, and HADS.

Results. Most of the analyzed studies reported higher quality-of-life and satisfaction scores after autologous reconstruction, particularly in the domains of satisfaction with breasts, satisfaction with outcome, psychosocial well-being, and sexual well-being. Results concerning physical well-being were less consistent. Implant-based reconstruction was associated with a shorter and less burdensome treatment course; however, its long-term results may be limited by implant-related complications and the effects of radiotherapy.

Conclusions. Autologous breast reconstruction appears to provide more favorable quality-of-life and satisfaction outcomes than implant-based reconstruction. Nevertheless, the choice of reconstructive method should be individualized and should consider the patient’s clinical status, planned oncological treatment, risk of complications, and personal preferences.