Abdominal-based vs. alternative flaps: Surgical outcomes and quality of life following different techniques of autologous breast reconstruction

Abdominal-based flaps are considered the gold standard for autologous breast reconstruction (ABR). With the increasing number of women undergoing mastectomy, however, alternative free flaps from other regions have emerged as valuable alternatives when patients do not qualify for an abdominal-based flap. This single-center cohort study evaluates objective and subjective outcomes in patients who underwent abdominal-based versus alternative flaps for breast reconstruction. Patients who underwent ABR between 2010 and 2022 were included. Baseline patient characteristics and data on oncological and surgical treatment were collected. Since 2018, all patients received the validated BREAST-Q questionnaire evaluating satisfaction and quality of life preoperatively and at regular intervals following surgery. Multinomial logistic regression evaluated the probability of flap complications based on the type of flap. We also evaluated quality of life between abdominal-based and alternative flaps. Of the 183 patients were included in this study (146 abdominal-based and 37 alternative flaps). We could not ascertain a relationship between type of flap and flap complications. More donor-site complications and more secondary aesthetic corrective surgery were noted in patients who underwent abdominal-based flaps. Our results did not show any differences between patients who underwent abdominal-based compared to alternative flap types for various satisfaction domains of the BREAST-Q. Abdominal-based and alternative free flap types are both viable treatment options in ABR and several variables need to be considered when selecting the appropriate flap for the right patient. Careful flap selection and the shared decision-making process between patient and surgeon reflect high patient-satisfaction and an optimal aesthetic result.