Abstract: Autologous or Implant-Based Breast Reconstruction? Crowdsourcing Aesthetic Preferences of the General Population

Abstract

INTRODUCTION: Post-mastectomy breast reconstruction (PMBR) is important for many women undergoing treatment for breast cancer; studies show that PMBR can improve body image, sexuality and overall quality of life.1 Aesthetic outcome is a significant component of patient satisfaction after PMBR and historically, has primarily been evaluated by patient and surgeon.2 The aim of this study is to evaluate public opinion of autologous and implant-based breast reconstruction. METHODS: In February 2017, a survey was distributed via a Crowdsourcing platform to members of the general population. Respondents rated the results of fourteen women’s breast reconstructions following treatment (seven autologous and seven implant-based PMBRs), ranking the attractiveness using a Likert scale with regard to shape, symmetry, nipples, natural appearance and overall appearance. Higher scores indicted a more positive response. RESULTS: A total of 203 responses were retrieved in the study period. The majority of respondents were Caucasian 61.6%) males (64.5%), with a mean age of 34.4 years. When comparing autologous with implant PMBR, mean overall appearance score was higher in autologous (3.07 vs. 2.83, p<0.001), as was that of the mean shape score (3.24 vs. 3.10, p=0.002), nipple score (3.06 vs. 2.87, p<0.001), scarring score (3.44 vs. 2.95, p<0.001), natural appearance score (3.29 vs. 2.79, p<0.001). On multivariate analysis, autologous PMBR was predictive of a higher preference score compared with implant PMBR (OR 1.42, CI 1.24–1.64). CONCLUSION: The public demonstrated an overall preference for the aesthetics of autologous over implant-based post-mastectomy breast reconstruction, independent of respondent characteristics. This information may provide further evidence supporting the use of autologous post-mastectomy breast reconstruction. Reference Citations: 1. Atisha D, Alderman AK, Lowery JC, Kuhn LE, Davis J, Wilkins EG. Prospective Analysis of Long-term Psychosocial Outcomes in Breast Reconstruction. Ann Surg. 2008;247:1019–28. 2. Mallucci P, Branford O. Population Analysis of the Perfect Breast: A Morphometric Analysis. Plast Reconstr Surg. 2014;134:436–47.