Outcomes of immediate implant-based vs. autologous breast reconstruction after neoadjuvant therapy

The choice of modality for immediate breast reconstruction (IBR) following neoadjuvant therapy (NAT) remains controversial. We compared the complications, aesthetic outcomes, and patient satisfaction between two IBR techniques, immediate autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBBR), in patients treated with NAT, with the goal of informing clinical practice.

Data from patients who underwent unilateral IBR after receiving NAT were retrospectively analyzed. Demographic characteristics, tumour profiles, treatment regimens, complication data, patient-reported outcomes, and aesthetic scores were compared between the groups. Subgroup analyses were also conducted separately for each group.

Of 172 patients who were included in the study, 97 underwent IBBR and 75 underwent ABR. Reconstruction failures (18.6% vs. 1.3%, p<0.001) and infection (13.4% vs. 4.0%, p=0.035) occurred more frequently in the IBBR than in the ABR group. Multivariable regression analysis showed that diabetes significantly increased reconstruction failure risk in the IBBR group (OR=16.14, 95% CI: 1.46-178.51, p=0.023), with infection also emerging as a notable risk factor (OR=5.26, 95% CI: 1.43-19.38, p=0.013). The IBBR group demonstrated significantly lower patient satisfaction scores compared to ABR patients (65.52±19.50 vs. 72.22±18.26, p=0.035). Aesthetic outcomes were analyzed by reconstruction stage, with significantly fewer people reporting "excellent" in the IBBR group than in the ABR group at the tissue expander phase (TEP) (65.6% vs. 89.5%, p=0.002).

Following NAT, fewer complications, higher patient satisfaction, and better aesthetic outcomes were observed with ABR compared to IBBR.