Autologous Versus Implant-Based Breast Reconstruction: Insights From Recent Oncologic and Plastic Surgery Guidelines

Mastectomy rates remain high in the management of breast cancer, which reflects the evolution of post-mastectomy breast reconstruction into a critical component of multidisciplinary care. The two primary methods for breast reconstruction consist of using the patient's own tissue (autologous) and implant-based procedures. The selection between the two procedures depends on three main factors, which include oncological requirements, surgical risk, and patient preferences. This article aims to synthesize recent clinical guidelines and literature to provide an evidence-based comparison of these surgical modalities. A comprehensive literature search was conducted to find current clinical practice guidelines and high-quality clinical studies about post-mastectomy breast reconstruction. The research assessed how cancer treatments affect patients through their evaluation of radiotherapy effects and complication rates, and patient-reported outcome measures (PROMs), which used the BREAST-Q tool for both autologous and implant-based groups. The use of prepectoral implants decreased pain and animation deformity but showed higher seroma rates and can also fail with radiotherapy. Autologous reconstruction provides superior long-term psychosocial and sexual life quality. The two main factors that determine reconstructive failure success rates include patients who are obese and smokers.