BREAST-Q outcomes after autologous breast reconstruction: a comparative analysis of deep inferior epigastric perforator, transverse rectus abdominis myocutaneous, and latissimus dorsi flaps
DOI:
https://doi.org/10.18203/2320-6012.ijrms20261861Keywords:
Breast reconstruction, Perception, Breast-Q, Deep inferior epigastric perforator, Transverse rectus abdominis myocutaneous, Latissimus dorsi flapAbstract
Background: Autologous breast reconstruction is commonly performed after mastectomy; however, the impact of different flap techniques on patient-reported outcomes remains unclear.
Methods: An observational, analytical, cross-sectional study was conducted at Hospital General de México “Dr. Eduardo Liceaga.” Thirty women who underwent unilateral breast reconstruction following mastectomy for breast cancer between 2016 and 2024 were included. Patients were reconstructed with a deep inferior epigastric perforator (DIEP) flap, Latissimus dorsi flap, or transverse rectus abdominis myocutaneous (TRAM) flap (n=10 per group). Patient-reported outcomes were assessed 12 months after surgery using the validated BREAST-Q questionnaire.
Results: The mean age was 51.6 years, with no significant differences among groups (p=0.225). Overall BREAST-Q scores were highest in the DIEP group (88.9), followed by the TRAM (84.2) and latissimus dorsi (82.3) groups. Most BREAST-Q domains showed no significant differences between reconstruction techniques, including psychosocial well-being, sexual well-being, satisfaction with breast appearance, adverse effects of radiation, satisfaction with information, satisfaction with the surgeon, satisfaction with the medical team, and satisfaction with staff (all p>0.05). Physical well-being of the chest was significantly higher in the Latissimus Dorsi group than in the DIEP and TRAM groups (p=0.045). Abdominal satisfaction was significantly higher in the DIEP group compared with the TRAM group (p<0.0001).
Conclusions: All three autologous reconstruction techniques achieved high postoperative satisfaction. Significant differences were observed only in chest physical well-being, favouring the latissimus dorsi flap, and abdominal satisfaction, favouring the DIEP flap. These findings support individualized flap selection according to patient priorities and expected donor-site outcomes.
References
Ellington TD, Miller JW, Henley SJ, Wilson RJ, Wu M, Richardson LC. Trends in Breast Cancer Incidence, by Race, Ethnicity, and Age Among Women Aged ≥20 Years - United States, 1999-2018. MMWR Morb Mortal Wkly Rep. 2022;71(2):43-7.
Giaquinto AN, Sung H, Newman LA, Freedman RA, Smith RA, Star J, et al. Breast cancer statistics 2024. CA Cancer J Clin. 2024;74(6):477-95.
Newman L. Oncologic anthropology: global variations in breast cancer risk, biology, and outcome. J Surg Oncol. 2023;128(6):959-66.
Rubenstein RN, Nelson JA, Azoury SC, Kim M, Boe LA, Chu JJ, et al. Disparity reduction in US breast reconstruction: an analysis from 2005 to 2017 using 3 nationwide data sets. Plastic Reconstruct Surg. 2024;154(6):1065e-75e.
Fox JP, Latham KP, Darmon S, Eaglehouse YL, Bytnar JA, Shriver CD, et al. Immediate Breast Reconstruction After Mastectomy for Cancer Among US Military Health System Beneficiaries. Ann Plastic Surg. 2025;94(1):20-5.
Malekpour M, Malekpour F, Wang HT. Breast reconstruction: Review of current autologous and implant-based techniques and long-term oncologic outcome. World J Clin Cases. 2023;11(10):2201-12.
Cho MJ, Schroeder M, Flores Garcia J, Royfman A, Moreira A. The Current State of the Art in Autologous Breast Reconstruction: A Review and Modern/Future Approaches. J Clin Med. 2025;14(5).
Hagiga A, Mabrouk A, Papadopoulos D, Ivanov A, Kyrtsonis G, Skepastianos G, et al. Autologous free-flap reconstruction following implant-based breast reconstruction: a single-centre experience and literature review. Eur J Plastic Surg. 2026;49(1):102.
Gallegos Sierra C, Morales Flores EA, Villarreal Salgado JL, Hernández Gómez G, Ramos Guerrero JA, Danilla S. Calidad de vida en reconstrucción mamaria postmastectomía. Aplicación del instrumento Breast-Q®. Cirugía Plástica Ibero-Latinoamericana. 2019;45(4):369-76.
Sadok N, Krabbe-Timmerman IS, Buisman NH, van Aalst VC, de Bock GH, Werker PMN. Short-Term Quality of Life after Autologous Compared with Alloplastic Breast Reconstruction: A Prospective Study. Plast Reconstr Surg. 2023;152(4S):55S-68S.
Sungkar A, Yarso KY, Nugroho DF, Wahid DI, Permatasari CA. Patients' Satisfaction After Breast Reconstruction Surgery Using Autologous versus Implants: A Meta-Analysis. Asian Pac J Cancer Prev. 2024;25(4):1205-12.
Tanas Y, Tanas J, Swed S, Spiegel AJ. A Meta-analysis Comparing Deep Inferior Epigastric Perforator Flaps and Latissimus Dorsi Flaps in Breast Reconstruction. Plast Reconstr Surg Glob Open. 2024;12(10):e6206.
Martins R, Otero P, Torres ÁJ, Vázquez FL. Quality of Life and Sexual Satisfaction in Women with Breast Cancer Undergoing a Surgical Treatment and in Their Male Partners. J Clin Med. 2022;11(23):6960.
Jenifer S, Raja S, Rajarathinam N, Jayram J, Meenakshisundaram M. Quality of life and sexual function after breast conservation surgery and mastectomy without reconstruction in South Indian patients. Tumor J. 2026;112(2):118-23.
Yueh JH, Slavin SA, Adesiyun T, Nyame TT, Gautam S, Morris DJ, et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg. 2010;125(6):1585-95.
Jeong W, Lee S, Kim J. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. Breast. 2018;38:45-51.
He WY, El Eter L, Yesantharao P, Hung B, Owens H, Persing S, Sacks JM. Complications and patient-reported outcomes after TRAM and DIEP flaps: a systematic review and meta-analysis. Plast Reconstruct Surg Global Open. 2020;8(10):e3120.
Waverley Y, He LEE, Yesantharao P, Azamfirei R, Owens H, Sacks JM. Comparing Clinical Outcomes For TRAM, DIEP, And Latissimus Dorsi Flap Breast Reconstructions: A Systematic Review And Meta-Analysis. 65th Annual Meeting Plastic Surgery. 2020.
Downloads
Published
How to Cite
Issue
Section
