Reconstrucción Mamaria Postmastectomía con Colgajos versus Implantes: Revisión Sistemática de Resultados Estéticos, Funcionales y Calidad de Vida

Introduction: Post-mastectomy breast reconstruction is an essential intervention to restore body image, psychological well-being, and quality of life in patients. The two main surgical strategies are reconstruction with autologous flaps (such as DIEP, TRAM, or LD) and breast implants (anatomical or round). Each technique has different implications in terms of aesthetics, function and morbidity, which has driven increasing comparative research (Nelson et al., 2019 [1]; Toyserkani et al., 2020 [2]). Methods: A systematic review was conducted according to PRISMA 2020 guidelines. Studies published between 2015 and 2024 were included, identified from PubMed, Embase, Scopus, and Cochrane. Inclusion criteria focused on research comparing aesthetic , functional, and quality of life outcomes between autologous and implant based techniques, using validated tools such as BREAST-Q, POSAS and BODY-Q. Thirty studies were included, with a total sample of over 62,000 patients. Results; Evidence suggests that flap-based reconstruction, particularly the DIEP flap, is associated with higher levels of aesthetic satisfaction, better body image perception, and greater psychosocial well being compared to implants ( Santosa et al., 2018 [3]; Kuiper et al., 2023 [22]; Roy et al., 2023 [12]). The meta-analysis by Toyserkani et al.Showed an average difference up to 10 points in the “ satisfaction with breasts” domain of the BREAST-Q in favor of flaps [2].In functional terms, although autologous reconstructions involve higher initial surgical morbidity, they present lower long term complication rates and less need for reoperations (Fischer et al., 2015 [5]; Lee et al., 2023 [16]). Additionally, the impact of scars, especially symptomatic ones, can negatively affect quality of life , with this effect being more pronounced in procedures lacking proper aesthetic planning (Everaars et al., 2024 [28]). Discussion: Despite their technical complexity, flap reconstructions offer superior aesthetic and functional outcomes, especially in young, active patients or those with high aesthetic demands (Weichman et al., 2015 [4]; Bastyr et al., 2021 [14]). Factors such as body mass index, oncological history, radiotherapy, and surgical timing (immediate vs delayed reconstruction) significantly influenced outcomes (Beugels et al., 2018 [17]; Honkanen et al., 2021 [23]). Nevertheless, methodological heterogeneity among studies and the presence of confounding variables such as adjuvant radiotherapy limit the generalizability of findings. Conclusion : Breast reconstruction with autologous flaps, particularly with the DIEP technique, is associated with better aesthetic results, a lower rate of long term complications, and greater overall satisfaction compared with implants. However, the surgical choice should be personalized based on the patient’s clinical profile, preferences, and long term goals. These findings support the need to update clinical guidelines to promote shared decision-making that is evidence based and patient centered.