Purpose: Previous studies suggest that patients who choose autologous breast reconstruction (ABR) have significantly better quality of life than those with implant-based reconstruction (IBR). This study aims to present factors associated with long-term Satisfaction with Breasts among patients who underwent abdomen-based ABR and assess the importance of revision procedures on postoperative satisfaction.
Methods: A retrospective analysis of patients who underwent abdomen-based ABR between 2010 and 2021 and completed the BREAST-Q Satisfaction with Breasts module at 1-year was performed. Elective revision procedure comprised of breast revision and nipple areolar complex (NAC) reconstruction.
Results: Overall, 959 patients who underwent ABR completed the BREAST-Q at 1-year follow-up. The median score significantly improved from 48 (interquartile range, 36 to 62) preoperatively to 64 (52 to 78) at 1-year postoperatively (p<0.001). Factors significantly associated with decreased postoperative Satisfaction with Breasts score included lower preoperative scores (β=0.11, 95% CI: 0.03, 0.19, p=0.005), Asian race (versus White, β=-6.3, 95% CI: -11, -1.3, p=0.014), and a history of psychiatric diagnoses (β=-3.6, 95% CI: -6.3, -0.82, p=0.011). Patients who received neoadjuvant/adjuvant radiation (β=-4.7, 95% CI: -7.9, -1.5, p=0.004) or had a complication of mastectomy skin flap/nipple necrosis (β=-4.1, 95% CI: -7.9, -0.34, p=0.033) had significantly decreased scores. Neither breast revision nor NAC reconstruction was significantly associated with 1-year Satisfaction with Breasts.
Conclusion: ABR significantly improves patients’ long-term Satisfaction with Breasts. Factors that influence satisfaction at 1-year include preoperative score, age, race, a history of psychiatric, radiation, and necrosis. Understanding these factors is imperative when managing expectations.