Comparison of surgical outcomes, safety, and cosmetic satisfaction between immediate implant-based and transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction following total mastectomy: a retrospective cohort study.

Background: Breast cancer is the most common female cancer. Current oncological therapies aim not only to eradicate the malignancy but also to preserve the patient's aesthetic bodily appearance. Breast reconstruction, either with an implant or via transverse rectus abdominis myocutaneous (TRAM), is an option for immediate post-mastectomy reconstruction; however, these two operations differ in outcomes in terms of operative time, blood loss, and complications. Furthermore, the two reconstructive techniques have distinct long-term complication profiles. Implant-based reconstruction is associated with the risk of capsular contracture, whereas pedicled TRAM flap reconstruction is more prone to fat necrosis related to flap perfusion. As cosmetic satisfaction is another important factor that should be considered, this study aimed to compare surgical outcomes and patient-reported cosmetic satisfaction between immediate implant-based breast reconstruction and pedicled TRAM flap reconstruction following total mastectomy. The two types of operations were performed by a single surgeon in Rajavithi Hospital, a tertiary referral institute in Thailand. Methods: A retrospective cohort study was conducted in female patients who underwent total mastectomy with immediate breast reconstruction between January 2018 and July 2023. Thirty patients underwent implant-based reconstruction and 30 underwent pedicled TRAM flap reconstruction. Patients with previous chest wall irradiation, neoadjuvant chemotherapy, clinical stage IV disease, or incomplete follow-up were excluded. After standardized preoperative counseling, reconstructive methods were selected based on patient preference, anatomical suitability, and clinical factors. All procedures were performed by a single breast surgeon experienced in breast surgery and reconstruction. Perioperative outcomes, postoperative complications, and patient-reported cosmetic satisfaction were compared between groups. Results: The implant-based reconstruction group was younger than the pedicled TRAM flap reconstruction group (43.03±6.08 Conclusions: Implant-based reconstruction after mastectomy was associated with shorter operative time, lower blood loss, and higher patient-reported overall and cosmetic satisfaction than pedicled TRAM flap reconstruction. However, patients in the implant-based reconstruction group were younger, which may have influenced breast shape and contour outcomes. Only minor differences in postoperative complications were observed between the groups. These findings suggest that implant-based reconstruction may be a favorable option for achieving satisfactory cosmetic outcomes and can be performed concurrently with mastectomy by a single breast surgeon.