Direct-to-Implant vs. Immediate Autologous Tissue Transfer: A Systematic Review and Meta-analysis of Patient Reported Outcomes after Immediate breast reconstruction

Purpose: The effect of immediate implant and autologous breast reconstruction on patient complication rates has been studied extensively, but patient-reported outcomes for these procedures during immediate, single-stage reconstruction has yet to be comprehensively investigated. This study compares patient-reported outcomes for immediate implant reconstruction with immediate autologous reconstruction to determine advantages and disadvantages for each surgical modality from the patient’s perspective. Methods: A literature search of PubMed between 2010 and 2021 was performed, and 21 studies containing patient-reported outcomes were selected for analysis. Meta-analysis of patient-reported outcome scores was performed separately for immediate breast reconstruction using autologous tissue transfer and synthetic implants. Results: Data was collected on 831 patients in the immediate reconstruction group and 511 in the delayed group, with a minimum of 3-month follow-up. The pooled mean of patients’ satisfaction with their breasts was 70.7±1.3 after immediate autologous reconstruction and 68.5±1.4 after immediate implant reconstruction, showing a statistically significant difference in outcome (p<0.05). The pooled mean of patients’ sexual well-being was 59.3±1.5 after immediate autologous reconstruction and 62.8±2.0 after immediate implant reconstruction (p<0.01). The pooled mean of patients’ satisfaction with their outcome was 78.8±2.6 after immediate autologous reconstruction and 82.3±1.8 after immediate implant reconstruction (p<0.05). The results of each meta-analysis were summarized on forest plots depicting the distribution of patient-reported outcome scores from each study. Conclusions: Immediate reconstruction with implants may have a similar or greater capacity to achieve patient satisfaction and improve QoL compared to immediate reconstruction with autologous tissue transfer when both reconstructive options are available.