Publication:

BREAST-Q outcomes after autologous breast reconstruction: a comparative analysis of deep inferior epigastric perforator, transverse rectus abdominis myocutaneous, and latissimus dorsi flaps

Background Autologous breast reconstruction is commonly performed after mastectomy; however, the impact of different flap techniques on patient-reported outcomes remains unclear.

Methods An observational, analytical, cross-sectional study was conducted at Hospital General de México “Dr. Eduardo Liceaga.” Thirty women who underwent unilateral breast reconstruction following mastectomy for breast cancer between 2016 and 2024 were included. Patients were reconstructed with a deep inferior epigastric perforator (DIEP) flap, Latissimus dorsi flap, or transverse rectus abdominis myocutaneous (TRAM) flap (n=10 per group). Patient-reported outcomes were assessed 12 months after surgery using the validated BREAST-Q questionnaire.

Results The mean age was 51.6 years, with no significant differences among groups (p=0.225). Overall BREAST-Q scores were highest in the DIEP group (88.9), followed by the TRAM (84.2) and latissimus dorsi (82.3) groups. Most BREAST-Q domains showed no significant differences between reconstruction techniques, including psychosocial well-being, sexual well-being, satisfaction with breast appearance, adverse effects of radiation, satisfaction with information, satisfaction with the surgeon, satisfaction with the medical team, and satisfaction with staff (all p>0.05). Physical well-being of the chest was significantly higher in the Latissimus Dorsi group than in the DIEP and TRAM groups (p=0.045). Abdominal satisfaction was significantly higher in the DIEP group compared with the TRAM group (p<0.0001).

Conclusions All three autologous reconstruction techniques achieved high postoperative satisfaction. Significant differences were observed only in chest physical well-being, favouring the latissimus dorsi flap, and abdominal satisfaction, favouring the DIEP flap. These findings support individualized flap selection according to patient priorities and expected donor-site outcomes.