Immediate Breast Reconstruction After Oncological Surgery: Surgical Decision-Making, Functional Preservation, and Long-Term Patient Outcomes

Immediate breast reconstruction has become an important component of comprehensive breast cancer management, integrating oncological safety, anatomical restoration, functional preservation, and patient-centered outcomes. However, selecting the most appropriate reconstructive technique remains challenging because of differences in surgical complexity, postoperative complications, radiotherapy requirements, and long-term satisfaction. This narrative review aimed to analyze the clinical and reconstructive factors influencing immediate breast reconstruction following mastectomy, emphasizing surgical technique selection, functional preservation, and patient-reported outcomes. Twenty scientific publications from 2010 to 2024 were examined through a descriptive, analytical, and comparative approach, incorporating international evidence and contributions from Latin America. The findings demonstrated considerable variability in postoperative complications among implant-based and autologous techniques, with some autologous procedures presenting higher overall complication rates but lower reconstructive failure rates. Prepectoral reconstruction was associated with reduced odds of animation deformity, capsular contracture, and prosthesis failure compared with subpectoral placement. Postmastectomy radiotherapy was associated with increased risks of severe capsular contracture, implant exposure, and reconstructive failure. Patient-reported outcomes indicated greater long-term breast satisfaction, psychosocial well-being, and sexual well-being following autologous reconstruction in selected populations. Evidence from Latin America documented changes in reconstructive practices and highlighted regional differences in healthcare resources. Overall, the findings support individualized reconstructive planning that prioritizes oncological safety while incorporating anatomical characteristics, functional outcomes, anticipated treatments, and patient preferences. Further prospective multicenter studies with standardized functional assessments and long-term follow-up are needed to strengthen comparative evidence and improve reconstructive decision-making.