Patient satisfaction with breast reconstruction: how much do timing and surgical technique matter?

Background Breast reconstruction (BR) has revealed significant benefits on physical and psychological well-being. Satisfaction is currently a key outcome on BR. This study aimed to assess the impact of timing and reconstructive technique on satisfaction, monitoring the influence of patient's characteristics and complications. Methods A single-center study of women undergoing primary BR over a 4.5-year period was conducted. Demographics, clinical features, procedural data, and postoperative complications were assessed. Patient satisfaction was evaluated with the BREAST-Q (TM). Influence of BR timing (immediate vs. delayed) and surgical technique (autologous vs. implant-based) on satisfaction was analyzed. Univariate and multivariate analyses were performed to identify independent predictors of satisfaction. Results Global response rate to BREAST-Q (TM) was 76.1% (216 from 284 patients). Responders underwent delayed BR in 67.6%, and autologous BR in 68.5%, with a 30.1% overall complication rate. Timing demonstrated significant impact on satisfaction (p = 0.001), with delayed reconstruction showing a higher mean BREAST-Q (TM) score. Autologous reconstruction also had a significantly higher BREAST-Q (TM) (p = 0.002). Transverse rectus abdominis myocutaneous flap presented the highest score, followed by latissimus dorsi with implant, and implant-based showed the lowest satisfaction (p = 0.004). Multivariate regression analysis identified timing, minor complications, and smoking status as independent impact factors of satisfaction (p = 0.001, p = 0.043, and p = 0.011, respectively). Conclusions Timing significantly affected satisfaction (delayed reconstruction evidencing positive influence). Technique did not reach significance as independent predictor. Smoking and minor complications showed negative influence. Meaningful satisfaction with delayed reconstruction may encourage BR in the majority of patients, even those with medical or oncologic risks that precluded immediate reconstruction. Level of evidence: Not ratable.