Comparison of Breast Reconstruction Strategies Using Exclusive Lipofilling or Prosthesis After Total Mastectomy for Breast Cancer: Satisfaction and Morbidity After More Than 2 Years.

Background: Total mastectomy for breast cancer is an impactful procedure, and breast reconstruction plays a crucial role for women diagnosed with the disease.

Objectives: The objective of our study is to compare satisfaction, morbidity, and timelines of two breast reconstruction techniques after breast cancer: breast prosthesis and exclusive lipofilling.

Methods: This is a comparative, retrospective, unicentric study on patients who underwent total mastectomy between May 2014 and May 2020. Satisfaction is assessed using the BREAST-Q questionnaire at least 2 years after the start of the reconstruction (4.8 (± 0.16) years in the implant group and 5.4 (± 0.12) years the lipofilling group, p value = 0.044). Morbidity is evaluated using the Clavien-Dindo classification.

Results: One hundred and one patients were included in the study (60 in the prosthesis group and 41 in the lipofilling group). The response rate to the questionnaire was 63.3% (38 patients) in the prosthesis group and 70.7% (29 patients) in the lipofilling group. The lipofilling technique appears to provide better satisfaction for the "sexual well-being" item of the BREAST-Q in multivariate analysis (65.75 +/-1.92 versus 54.87 +/-1.46, multivariate p-value = 0.03). Major complication (grade III, IV or V) rate was 20% in the prosthesis reconstruction group compared to 0% in the lipofilling group (multivariate p-value = 0.05). Lipofilling often requires longer reconstruction times, but reoperations are more frequent in prosthesis reconstruction, extending the reconstruction periods.

Conclusions: Our data should be confirmed by other studies to better guide the choice of reconstruction type.