Eight Women With Autologous Fat Transfer and Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Which Do They Prefer, and Why?

Background: Autologous fat transfer (AFT) is emerging as an alternative autologous reconstruction postmastectomy. This study compared patient-reported outcomes of AFT and deep inferior epigastric perforator (DIEP) flap in women who underwent both procedures Methods: In this mixed-methods, cross-sectional study, 8 women meeting inclusion criteria completed BREAST-Q and BODY-Q surveys, of whom 6 subsequently participated in semistructured interviews. Quantitative data compared satisfaction, physical well-being, and sensation. Qualitative thematic analysis explored patient experiences. Additional clinical data were collected retrospectively. Results: DIEP flap reconstruction showed superior scores across domains, with a statistically significant advantage in physical well-being ( P = 0.029, Cohen d = 0.80). Satisfaction and sensation differences were small to moderate, with qualitative data revealing more nuanced experiences. Participants described DIEP flap reconstruction as a 1-time, more invasive procedure with longer recovery and visible scarring, whereas AFT was perceived as gradual, less traumatic, and associated with minimal scarring, albeit requiring multiple sessions and showing variable volume retention. Sensory recovery was limited in both. Decision-making was influenced by treatment availability and patient values, in which social support played a critical role. Conclusions: In this exploratory study of women who experienced both DIEP flap and AFT breast reconstruction, AFT appeared to yield satisfaction similar to DIEP flap reconstruction, but further research is required to validate these observations.