Comparative outcomes of autologous and implant-based breast reconstruction techniques: evidenced-based perspectives
DOI:
https://doi.org/10.18203/2349-2902.isj20251923Keywords:
Breast reconstruction, Autologous flap, DIEP flap, TRAM flap, Implant-based reconstruction, Long-term outcomes, Patient satisfaction, Complication profiles, Oncologic considerationsAbstract
Breast reconstruction techniques differ widely in their utilization of tissue, associated donor site morbidity, complication profiles, and patient-reported outcomes. Autologous options, such as the deep inferior epigastric perforator (DIEP) and transverse rectus abdominis myocutaneous (TRAM) flaps, are preferred for their superior long-term satisfaction, better aesthetic results, and lower complication rates, particularly in patients who have received radiotherapy. While implant-based reconstruction offers a less invasive and faster recovery alternative, it is associated with higher long-term complication rates and lower patient satisfaction. The choice of technique should consider individual patient factors, oncologic safety, and personal preferences, as the long-term quality of life and satisfaction are more closely linked to the reconstructive method than to the timing of surgery. Overall, autologous reconstructions tend to provide more durable, satisfying outcomes, emphasizing their role in personalized breast cancer care.
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References
Erdmann-Sager J, Wilkins EG, Pusic AL, Ji Q, Hamill JB, Kim HM, et al. Complications and Patient-Reported Outcomes After Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. Plastic Reconstruct Surg. 2018;141(2):271-81. DOI: https://doi.org/10.1097/PRS.0000000000004016
Zoghbi Y, Gerth DJ, Tashiro J, Golpanian S, Thaller SR. Deep Inferior Epigastric Perforator Versus Free Transverse Rectus Abdominis Myocutaneous Flap: Complications and Resource Utilization. Ann Plastic Surg. 2017;78(5):516-20. DOI: https://doi.org/10.1097/SAP.0000000000000936
Nahabedian MY, Tsangaris T, Momen B. Breast Reconstruction With the DIEP Flap or the Muscle-Sparing (MS-2) Free TRAM Flap: Is There a Difference? Plastic Reconstruct Surg. 2005;115(2):436-44. DOI: https://doi.org/10.1097/01.PRS.0000149404.57087.8E
Yueh JH, Slavin SA, Adesiyun T, Theodore TN, Shiva G, Donald JM, et al. Patient Satisfaction in Postmastectomy Breast Reconstruction: A Comparative Evaluation of DIEP, TRAM, Latissimus Flap, and Implant Techniques. Plastic Reconstruct Surg. 2010;125(6):1585-95. DOI: https://doi.org/10.1097/PRS.0b013e3181cb6351
Lee KT, Kim J, Jeon BJ, Jai KP, Bang SI, Goo-Hyun M. Longitudinal Analysis of Long-Term Outcomes of Abdominal Flap-Based Microsurgical Reconstruction and Two-Stage Prosthetic Reconstruction. Sci Rep. 2023;13(1):4062. DOI: https://doi.org/10.1038/s41598-023-31218-2
Colwell AS, Taylor EM. Recent Advances in Implant-Based Breast Reconstruction. Plastic Reconstruct Surg. 2020;145(2):421e-32. DOI: https://doi.org/10.1097/PRS.0000000000006510
Petit JY, Rietjens M, Lohsiriwat V, Piercarlo R, Cristina G, De Lorenzi F, et al. Update on Breast Reconstruction Techniques and Indications. World J Surg. 2012;36(7):1486-97. DOI: https://doi.org/10.1007/s00268-012-1486-3
Petit J, Rietjens M, Garusi C. Breast Reconstructive Techniques in Cancer Patients: Which Ones, When to Apply, ¿Which Immediate and Long Term Risks? Crit Rev Oncol/Hematol. 2001;38(3):231-9. DOI: https://doi.org/10.1016/S1040-8428(00)00137-2
Colwell AS, Christensen JM. Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction. Plastic Reconstruct Surg. 2017;140(5S):44S-50. DOI: https://doi.org/10.1097/PRS.0000000000003949
Rocco N, Catanuto GF, Accardo G, Nunzio V, Paolo C, Michela C, et al. Implants Versus Autologous Tissue Flaps for Breast Reconstruction Following Mastectomy. Cochrane Database Systemat Rev. 2024;10:CD013821. DOI: https://doi.org/10.1002/14651858.CD013821.pub2
Thai JN, Sodagari F, Colwell AS, Winograd JM, Margarita VR, Hagar M, et al. Multimodality Imaging of Postmastectomy Breast Reconstruction Techniques, Complications, and Tumor Recurrence. Radiographics. 2024;44(5):e230070. DOI: https://doi.org/10.1148/rg.230070
Thiessen FEF, Tjalma WAA, Tondu T. Breast Reconstruction After Breast Conservation Therapy for Breast Cancer. Eur J Obstet Gynecol Reproduct Biol. 2018;230:233-8. DOI: https://doi.org/10.1016/j.ejogrb.2018.03.049
Johnson L, White P, Jeevan R, Browne J, Gulliver-Clarke C, O'Donoghue J, et al. Long-Term Patient-Reported Outcomes of Immediate Breast Reconstruction After Mastectomy for Breast Cancer: Population-Based Cohort Study. Brit J Surg. 2023;110(12):1815-23. DOI: https://doi.org/10.1093/bjs/znad276
Nelson JA, Allen RJ, Polanco T, Shamsunder M, Patel AR, McCarthy CM, et al. Long-Term Patient-Reported Outcomes Following Postmastectomy Breast Reconstruction: An 8-Year Examination of 3268 Patients. Anna Surg. 2019;270(3):473-83. DOI: https://doi.org/10.1097/SLA.0000000000003467
Pusic AL, Matros E, Fine N, Edward B, Gayle MG, Jennifer BH, et al. Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. J Clin Oncol. 2017;35(22):2499-506. DOI: https://doi.org/10.1200/JCO.2016.69.9561
Ren Y, Yu Y, Xu K, Li Z, Wang X. Meta-analysis of immediate implant-based breast reconstruction versus autologous breast reconstruction in the setting of PMRT. Aesthet Plastic Surg. 2024;48(10):1940-8. DOI: https://doi.org/10.1007/s00266-023-03430-y
Esparham A, Shoar S, Whittington J, Shafaee Z. National trends and in-hospital outcomes for immediate implant-based versus autologous-based breast reconstruction: a propensity score-matched analysis. Ann Surgical Oncol. 2025;32(2):985-92. DOI: https://doi.org/10.1245/s10434-024-16255-z
Muntean MV, Pop IC, Ilies RA, Pelleter A, Vlad IC, Achimas-Cadariu P. Exploring the Role of Autologous Fat Grafting in Implant-Based Breast Reconstruction: A Systematic Review of Complications and Aesthetic Results. J Clin Med. 2025;14(12):4073. DOI: https://doi.org/10.3390/jcm14124073
Sungkar A, Yarso KY, Nugroho DF, Wahid DI, Permatasari CA. Patients’ Satisfaction After Breast Reconstruction Surgery Using Autologous versus Implants: A Meta-Analysis. Asian Pacific J Cancer Prevention. 2024;25(4):1205. DOI: https://doi.org/10.31557/APJCP.2024.25.4.1205
Cho MJ, Schroeder M, Flores Garcia J, Royfman A, Moreira A. The Current State of the Art in Autologous Breast Reconstruction: A Review and Modern/Future Approaches. J Clin Med. 2025;14(5):1543. DOI: https://doi.org/10.3390/jcm14051543