D144. A Return to Baseline: Superior Long-Term Patient-Reported Psychosocial Outcomes in Autologous Breast Reconstruction

PURPOSE: Breast sensation after postmastectomy reconstruction has become increasingly important to patients and surgeons alike, garnering attention on a national scale. Our team has previously shown superior sensory recovery in autologous compared to alloplastic reconstruction, but without full understanding of psychosocial impact on the patient. In this study, we build on our previous work by evaluating patient-reported outcomes and comparing them to cutaneous breast sensation. METHODS: Women undergoing mastectomy with immediate two-stage implant-based reconstruction or deep inferior epigastric perforator (DIEP) flap were prospectively identified and underwent neurosensory testing with a pressure-specified sensory device and administration of a BREAST-Q survey at defined time points. The Psychosocial Wellbeing, Sexual Wellbeing, Satisfaction with Breasts, and Chest Wellbeing scores were compared between the two reconstruction groups. RESULTS: 149 patients (77 implant and 72 DIEP) were included in this cohort. Psychosocial Outcomes were expectedly low the first year after surgery, but the DIEP cohort's scores increased in the years following, whereas the implant cohort's scores remained stable. Two years after surgery, the DIEP cohort's Psychosocial Outcomes score returned to preoperative levels, significantly higher than the implant-based group's score (87 vs. 70, p=0.042). The other BREAST-Q scales saw similar temporal patterns, but without significant inter-group differences. CONCLUSION: Autologous breast reconstruction has superior psychosocial recovery, with eventual return to baseline. This mirrors our prior findings of superior sensation recovery of autologous flaps.