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Patient Priorities and Satisfaction in Autologous Breast Reconstruction: Aesthetic Outcomes and Insights
Salman Khan
*, Malia Voytik, Margaret M. Hornick, Ayaka N. Deguchi, Robyn B. Broach, Jessica Rose
University of Pennsylvania, Philadelphia, PA
Purpose
Achieving optimal aesthetics in autologous breast reconstruction (ABR) requires understanding patient-defined aesthetic preferences. . This study provides novel insights into the nuances of patient priorities.
Methods
An aesthetic opinion survey was distributed to all patients who underwent ABR patients at a single institution from 2017 to 2023.
Results
Of 301 eligible patients, 156 responded (52.1%), with a mean age of 55 years (SD = 10) and BMI of 28.6 kg/m
2 (SD = 5.6). The majority identified as White (80%), followed by Black (8.6%) and other (12%). Breast symmetry ranked as the top priority (mean = 1.9, SD = 1.2), followed by shape/contour (2.6, 1.3) and position (3.1, 1.6). NAC (5.3, 1.8) and donor site aesthetics (5.7, 1.6) ranked lowest.
Overall, 66% of patients reported satisfaction with breast aesthetics and 58% with donor site appearance. Satisfaction was highest for symmetry (76%) and position (79%), and lowest for NAC aesthetics (48%) and donor site scar characteristics, including color (53%) and size (47%).
Racial differences were significant. Breast symmetry was the top priority for 51% of White but only 10% of Black patients (p < 0.05), whereas 64% of Black patients prioritized shape/contour vs. 26% of White patients (p < 0.05). Black patients reported greater dissatisfaction with breast (p = 0.006) and donor site (p = 0.08) aesthetics, including breast scars (33.3% vs. 22.7%, p = 0.11) and donor site scar color (25% vs. 6.6%, p = 0.05). No differences were observed by BMI, age, or time since surgery (all p > 0.05).
Conclusion
Patient-defined aesthetic priorities and satisfaction following ABR vary, particularly across racial groups. Addressing these differences through tailored communication and individualized care plans can improve overall patient satisfaction and ABR effectiveness.
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