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Psychosocial Well-being in Autologous vs. Implant Breast Reconstruction: A Propensity Matched Analysis
Ariel Gabay
*1, Abigail Tirrell
1, Lillian A. Boe
2, Carrie S. Stern
1, Babak J. Mehrara
1, Jonas Nelson
11Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York , NY; 2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
Background: Autologous breast reconstruction (ABR) has been associated with superior patient-reported outcomes (PROs) compared to implant-based breast reconstruction (IBBR). However, prior studies examining psychosocial wellbeing are limited by small sample size, inadequate confounder control, and short follow-up periods, precluding definitive conclusions about modality-specific psychosocial effects. We aimed to compare BREAST-Q Psychosocial Well-Being scores between ABR and IBR using propensity score matching.
Methods: Female patients undergoing ABR or IBBR (two staged and direct-to-implant) between 2017-2024 with at least one preoperative and postoperative BREAST-Q score were included. Separate 1:1 propensity matching was performed at each timepoint (6 months, 1-5 years) on: age, BMI, race, ethnicity, smoking, radiation timing, chemotherapy timing, laterality, and psychiatric diagnosis. Psychosocial well-being scores and change from baseline (Δ) were compared using Wilcoxon signed-rank tests.
Results: The unmatched cohort comprised 8,004 patients (ABR=2,030; IBBR=5,974). IBR patients had higher absolute psychosocial scores preoperatively through 4-years postoperatively (all p<0.001), while ABR demonstrated greater improvement from baseline at all timepoints after 1-year postoperative (all p<0.05). After propensity matching, absolute scores were comparable between cohorts at 1-year and after (1YR: 69 ABR vs. 69 IBBR, p=0.3; 2YR: 69 vs. 69, p=0.8; 3YR: 71 vs. 71, p=0.8; 4YR: 69 vs 71, p=0.2; 5YR: 77 vs. 69, p=0.4), except for at 6MO with IBBR having higher scores (69 vs 62, p<0.001).
Conclusions: After propensity matching, psychosocial well-being scores were equivalent between ABR and IBR from 1-year onward. Previously reported ABR superiority likely reflects inadequate control for cofounders and small sample size. ABR patients experience a transient early decline before achieving equivalent long-term scores, which may help guide psychosocial support in the early postoperative period.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
