Indications and Outcomes of Autologous Conversion from Implant-based Breast Reconstruction

Background In this study, we explored the transition from implant-based to autologous breast reconstruction, focusing on the factors prompting conversion, patient outcomes, and the role of emerging flap types such as PAP and LAP in reconstruction choices. Historically, implant-based methods dominated breast reconstruction, but limitations and complications have led a subset of patients to prefer autologous reconstruction, especially after radiation therapy. This research aims to elucidate the decision-making process behind switching to autologous methods, examining a broad range of patient demographics and conversion factors. Methods A retrospective review was conducted using REDCap database information from January 2012 to August 2023, including 119 patients who converted from implant-based to autologous reconstruction and 1329 who underwent primary autologous reconstruction. Data analysis covered demographics, comorbidities, reasons for conversion, types of surgeries performed, and BREAST-Q responses to assess satisfaction and quality of life. Results Indications for conversion included capsular contracture, dissatisfaction, and complications from previous treatments. Patients undergoing autologous conversion typically experienced more revision surgeries compared to those with primary autologous reconstruction. Notably, emerging flap options like PAP and LAP were more frequently utilized in conversions. BREAST-Q scores showed no significant preoperative differences, but postoperative satisfaction varied, highlighting the nuanced outcomes of reconstruction choices. Conclusion In conclusion, converting to autologous breast reconstruction offers a patient-centered alternative for those facing implant-based reconstruction failures, underscoring the need for individualized surgical approaches. This study contributes valuable insights into optimizing reconstructive outcomes by understanding patient preferences and advancements in flap techniques.