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.