Propensity-matched Analysis Of Clinical And Health Related Quality Of Life After Breast Reconstruction: Comparing Autologous And Implant-based Techniques
Meghana G. Shamsunder, MPH, Thais O. Polanco, MD, Robert J. Allen, Jr., MD, Colleen M. McCarthy, MD, Evan Matros, MD, Joseph H. Dayan, MD, Joseph J. Disa, MD, Peter G. Cordeiro, MD, Babak J. Mehrara, MD, Andrea L. Pusic, MD, Jonas A. Nelson, MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Introduction: The aim of this study is to compare clinical and health related-quality of life outcomes(HR-QoL) outcomes in patients undergoing implant(IBR) or autologous(ABR) breast reconstruction using a propensity matched analysis.
Methods: Propensity score matching analysis (nearest neighbor, 2:1 matching with replacement) was performed for immediate ABR or IBR patients with postoperative BREASTQ scores (1-2 years). Matched covariates included age, body mass index(BMI), race/ethnicity, smoking status, history of mental illness, any radiotherapy, and laterality of reconstruction. Outcomes of interest were breast satisfaction scores and complications.
Results: Initially, 2111 patients were evaluated with 460 patients included in the final analysis after matching(159 ABR and 261 IBR). The matched cohort had no differences in baseline characteristics. On average, ABR patients had significantly higher breast satisfaction scores at 1-2 years postoperatively compared to IBR patients(p=0.013; Figure 1.). Despite ABR patients having experienced significantly higher complications for: mastectomy skin flap necrosis(p<0.001), breast fat necrosis(p< 0.001), breast hematoma(p<0.001), breast cellulitis (p=0.01) and breast delayed wound healing(p< 0.001), this cohort experienced significantly less reconstructive failure compared to IBR patients(p<0.001). At every World Health Organization defined BMI category (excluding underweight), ABR patients had higher satisfaction scores compared to IBR patients.
Conclusion: In a matched analysis where a patient can equally receive either ABR or IBR, ABR is associated with higher postoperative breast satisfaction even in the setting of a higher perioperative complication profile. 
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