Quality of Life after Alloplastic versus Autologous Breast Reconstruction: The Influence of Patient Characteristics on Outcomes.

Objective: Quality of life (QoL) following autologous breast reconstruction has been found to be higher compared to alloplastic breast reconstruction. However, evaluating QoL is complex as it is influenced by various factors, including patient characteristics and treatment types. Previous studies comparing QoL between reconstruction techniques have not sufficiently addressed baseline differences between patient groups, some of which contribute to indication bias. Using an alternative approach to identify the confounders, this study aimed to evaluate which factors affect the patient satisfaction and QoL after alloplastic or autologous reconstruction, with follow-up extending up to 3 years post-surgery. Method: QoL and satisfaction were measured using the Breast-Q preoperatively and after breast reconstruction (post-BR) at 6 weeks, 6 months, 1 year, and 3 years. General and mental health were measured using the SF-36 and the HADS. A generalized linear mixed model was utilized to assess which factors confound the relationship between reconstruction technique and Breast-Q scores. Results: Factors contributing to the disparity in Breast-Q scores between autologous and alloplastic breast reconstruction varied across Breast-Q subscales. Autologous breast reconstruction patients consistently reported higher "Satisfaction with Breasts" and "Physical Well-being," while the minimal important differences in "Psychosocial" and "Sexual Well-being" were lost after adjustment for confounding factors. Conclusion: This study confirms that even when adjusted for confounders, scores on two QoL subscales autologous breast reconstruction patients score significantly higher over time. Although autologous reconstruction remained superior regarding "Satisfaction with Breasts," scores decreased in autologous reconstruction patients when they were depressed at baseline, underwent radiotherapy, had a history of breast cancer, or faced major complications.