Satisfaction with Breasts Following Autologous Reconstruction: Assessing Associated Factors and the Impact of Revisions

Background: Autologous breast reconstruction (ABR) may confer higher patient reported outcomes than implant breast reconstruction, but an in-depth examination of factors associated with satisfaction after ABR is lacking. We aimed to determine independent predictors of 1-year Satisfaction with Breasts after ABR and assess the importance of elective procedures on satisfaction. Methods: A retrospective analysis of patients who underwent abdominal-based ABR between 2010 and 2021 and completed the BREAST-Q Satisfaction with Breasts module at 1-year was performed. Elective procedures comprised of breast revision and nipple areolar complex (NAC) reconstruction. Results: 959 patients were included. Satisfaction with Breasts score improved from 53 (IQR: 44 to 64) preoperatively to 64 (53 to 78) at 1-year postoperatively (p<0.001). Factors significantly associated with decreased postoperative score included lower preoperative scores (β=0.19 [95% CI: 0.08, 0.31], p=0.001), older age (β=-0.17 [-0.34, -0.01], p=0.042), Asian race (versus White, β=-6.7 [-12, -1.7], p=0.008), and a history of psychiatric diagnoses (β=-3.4 [-6.2, -0.66], p=0.015). Patients who received radiation (β=-5.6 [-9.0, -2.3], p=0.001) or had mastectomy skin flap/nipple necrosis (β=-3.8 [-7.6, -0.06], p=0.046) also had significantly decreased scores. Satisfaction with Breasts significantly improved after breast revision procedures (54 [42 to 65] to 65 [54 to 78], p<0.001) and NAC reconstruction (58 [47 to 71] to 67 [57 to 82], p<0.001). Conclusion: Multiple independent patient and treatment level factors are associated with lower 1-year Satisfaction with Breasts following ABR. Elective procedures have the potential to improve satisfaction. Understanding these findings is imperative for optimizing clinical decision making and managing expectations.