Quality-of-life following implant-based vs DIEP-flap breast reconstruction: An Australian Perspective

Introduction: Breast reconstruction (BR) aims to improve breast cancer patient's quality of life (QoL). The decision to undergo BR is a personal decision often associated with anxiety and stressors surrounding mastectomy and BR options. Implant-based and DIEP-flap breast reconstruction remain the most popular options for BR in post-mastectomy patients. While post-mastectomy BR has proven QoL benefits, we aimed to investigate the QoL of BR patients at various points when making decisions surrounding BR. We evaluated the timing of radiotherapy, mastectomy type (NSM vs SSM), reconstruction technique (implant vs. DIEP flap) and procedure laterality (unilateral vs. bilateral) on patient-perceived postoperative quality of life (QoL). Method: Patients who underwent post-mastectomy breast reconstruction between January 2020 and December 2021 were invited to complete a Breast-Q and SF-12 questionnaire. Patient demographic data, surgical and oncological data were retrospectively collected. The results were compared between the timing of radiation, reconstruction type, reconstruction laterality and type of mastectomy. Chi-square tests, one-way analysis of variance (ANOVA) tests was used, and a multivariable linear regression was performed to adjust differences in SF-12 and BREAST-Q scores. Results: In total, 64 DIEP-flap and 63 implant-based reconstructive patients were included in the study. No significant differences in the SF-12 scores were demonstrated between reconstruction types. In BREAST-Q domains, DIEP-flap patients scored higher on satisfaction with breasts and psychosocial well-being. Implant patients scored higher in sexual well-being. There were no significant differences in QoL domains between reconstruction type, the timing of radiation, mastectomy type or laterality. Conclusion: While differences in QoL between implant-based and DIEP-flap BR exist, there is no significant difference between QoL at various points of the BR decision-making pathway. It is important to discuss all BR options to allow patients to make an informed decision when selecting a suitable BR option.