Analysis of Aesthetic Outcomes and Patient Satisfaction After Delayed-Immediate Autologous Breast Reconstruction

Background: Patientswith breast cancer frequently opt to undergo breast reconstruction after mastectomy. The timing and aesthetic outcome of the breast reconstruction may be affected by the need for radiation therapy (RT). Delayed-immediate autologous reconstruction (DIAR) is a novel surgical approach for patients in whom the need for adjuvant RT after mastectomy is preoperatively unknown. Aim: We sought to evaluate the difference in clinical outcomes, patient satisfaction, and cosmetic results between DIAR and patients who underwent delayed autologous reconstruction. Materials and Methods: A total of 19 DIAR and 19 delayed patients were retrospectively included. Patient demographics, surgical characteristics, and complications were obtained from patient files. Patients scored their satisfaction using the breast-Q questionnaire, and independent reviewers scored cosmetic outcomes, including skin quality/color, scar formation, symmetry, breast contour/size/position, and overall aesthetic outcome. The DIAR patients were matched to delayed patients based on age, body mass index, and unilateral or bilateral reconstruction. Results: The median age in the delayed group was 48 years (range, 31-61 years) and 46 years (range, 29-64 years) in the DIAR group, with a median body mass index of 28.8 (range, 21.4-40.5) and 28.6 (range, 24-1.9), respectively. There were no significant differences in demographics between the two groups. In total, 16 patients underwent unilateral reconstruction and 22 patients bilateral reconstruction. Delayed-immediate autologous reconstruction was associated with a higher infection rate compared with delayed reconstruction, 8 and 1, respectively (P = 0.026). All infections in the DIAR group were tissue expander-related. The DIAR patients had significantly better breast contour/size/position and overall aesthetics compared with the delayed reconstruction group (P = 0.001). In addition, patients who did not receive RT had significant better cosmetic outcome (P < 0.001). There were no significant differences in patient satisfaction between the DIAR and delayed group. Conclusion: Delayed-immediate autologous reconstruction should be considered as an option for patients wanting autologous reconstruction when the need for RT remains unknown. Delayed-immediate autologous reconstruction demonstrates better breast contour/size/position and overall aesthetic outcome.