Autologous Versus Implant Breast Reconstruction: Postoperative Risks and Quality of Life
Posted: Friday, August 24, 2018
Women who opt for autologous breast reconstruction appear to be at greater risk of postoperative complications than those who receive artificial implants, according to two studies published in JAMA Surgery. However, those who have autologous breast reconstruction also reported higher satisfaction and a greater degree of psychosocial and sexual well-being compared with those who opted for implants. The results may inform patients and clinicians of the risks and expectations associated with different reconstructive techniques and assist in shared decision-making.
“The key takeaway from this research is that these are complicated decisions,” one of the authors of both studies, Edwin G. Wilkins, MD, MS, of the University of Michigan Health System, Ann Arbor, shared in a press release. The operations come with risk no matter which choice the patient and their clinicians make.
The authors recruited 2,343 eligible patients using data from the Mastectomy Reconstruction Outcomes Consortium. Several different autologous and artificial surgery options were evaluated, including direct-to-implant technique, expander-implant technique, latissimus dorsi flap, pedicled transverse rectus abdominis myocutaneous flap, free transverse rectus abdominis myocutaneous flap, deep inferior epigastric perforator flap, and superficial inferior epigastric artery flap. Patients were followed for at least 2 years after surgery.
Overall, about one-third of all patients (32.9%) experienced complications, with nearly 20% having reoperative complications and almost 10% having wound infections. Patients who had autologous reconstruction experienced significantly higher chances of developing complications 2 years after surgery than did those who had implant surgeries. Flap procedures, with the exception of the latissiumus dorsi flap, were also associated with higher reoperative complications than artificial implant techniques. Of the patients who had autologous techniques, the deep inferior epigastric perforator flap alone had significantly lower odds of infection than did implant procedures.
A total of 1,217 patients (about 60% of participants in the Mastectomy Reconstruction Outcomes Consortium study) completed questionnaires 2 years after breast reconstruction surgery. Women who had autologous techniques reported greater satisfaction with their breasts (P < .001) as well as greater degrees of psychosocial well-being (P = .002) and sexual well-being (P < .001) compared with those who had implant reconstruction.
