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The study that lets a woman compare the two kinds of reconstruction honestly. Building a breast from her own tissue gives her a result she is happier with two years later; it also roughly doubles the chance of a complication and of needing another operation to fix one.
MROC recruited 2,343 women having first-time reconstruction after mastectomy from eleven North American centres and 57 plastic surgeons between February 2012 and July 2015, and followed them for two years with both complication data and the BREAST-Q, a validated patient-reported outcome instrument. 1,525 (65.1 percent) had expander-implant reconstruction, 112 (4.8 percent) direct-to-implant, 390 (16.6 percent) deep inferior epigastric perforator flaps, and the rest other flaps.
On satisfaction, 1,217 women (60.5 percent) answered at two years. After adjustment for baseline characteristics, autologous reconstruction beat implant reconstruction on satisfaction with breasts (difference 7.94 points, 95 percent confidence interval 5.68 to 10.20, p<0.001), psychosocial wellbeing (3.27, 1.25 to 5.29, p=0.002) and sexual wellbeing (5.53, 2.95 to 8.11, p<0.001).
On complications the direction reverses. Complications occurred in 771 women (32.9 percent), reoperative complications in 453 (19.3 percent) and wound infections in 230 (9.8 percent). Against expander-implant reconstruction, every autologous technique carried higher odds of any complication: deep inferior epigastric perforator flap 1.97 (1.41 to 2.76, p<0.001), free transverse rectus abdominis myocutaneous flap 2.05 (1.24 to 3.40), the pedicled version 1.91 (1.10 to 3.31), latissimus dorsi 1.87 (1.03 to 3.40) and superficial inferior epigastric artery flap 4.71 (2.32 to 9.54). All the flap procedures except latissimus dorsi also carried higher odds of a reoperative complication.
One number runs the other way and matters for a woman choosing. Failure of the reconstruction was commonest with implants: 7.1 percent for the expander-implant and direct-to-implant techniques, against 1.3 percent for deep inferior epigastric perforator flaps, 2.1 percent for free transverse rectus abdominis myocutaneous flaps and none for superficial inferior epigastric artery flaps (p<0.001). The trade is a higher chance of something going wrong against a lower chance of the whole reconstruction being lost.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
2,343 enrolled.
95 percent confidence interval 5.68 to 10.20, p<0.001
Source95 percent confidence interval 1.41 to 2.76, p<0.001
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Satisfaction with breasts at 2 years, adjusted difference on the BREAST-Qprimary | Autologous reconstruction against implant reconstruction | - | 7.94 points | - | - | link |
| Any complication within 2 years, deep inferior epigastric perforator flap against expander-implant | Deep inferior epigastric perforator flap | 390 | 1.97 odds ratio | - | - | link |
| Reconstruction failure within 2 years | Expander-implant and direct-to-implant | - | 7.1% | - | <0.001 | link |
| Deep inferior epigastric perforator flap | 390 | 1.3% | ||||
| Free transverse rectus abdominis myocutaneous flap | 95 | 2.1% |
Shares Pre-BRA (pre-pectoral breast reconstruction evaluation), iBRA (implant Breast Reconstruction evAluation), Breast reconstruction, Mastectomy.
Shares iBRA (implant Breast Reconstruction evAluation), Breast reconstruction, Mastectomy, HER2-positive breast cancer.
Shares Body image after breast surgery and reconstruction, iBRA (implant Breast Reconstruction evAluation), Breast reconstruction, Mastectomy.
Shares Breast reconstruction, Mastectomy, HER2-positive breast cancer, Breast cancer (all types).
Shares Breast reconstruction, Mastectomy, HER2-positive breast cancer, Breast cancer (all types).
Shares Breast reconstruction, Mastectomy, HER2-positive breast cancer, Breast cancer (all types).
Shares Mastectomy, HER2-positive breast cancer, Breast cancer (all types), Triple-negative breast cancer (TNBC).
Shares Mastectomy, HER2-positive breast cancer, Breast cancer (all types), Triple-negative breast cancer (TNBC).