Michele Riccio, Nicola Zingaretti, Angelica Aquinati, Andrea Giuseppe Ferraro, Enrico Lenti, Andrea Marchesini, Giuseppe Andrea Ferraro, Pier Camillo Parodi, Francesco De Francesco
An integrated onco-aesthetic approach was associated with substantial improvements in patient-reported outcomes, favorable aesthetic results, and high implant retention. Patient satisfaction was more closely related to achieved aesthetic quality than to contralateral symmetrization itself, supporting individualized bilateral reconstructive planning.
BACKGROUND: Immediate implant-based breast reconstruction has evolved toward an onco-aesthetic strategy integrating oncologic safety, aesthetic optimization, bilateral balance, and patient-centered outcomes. This study evaluated the clinical, aesthetic, and patient-reported outcomes of an integrated onco-aesthetic reconstructive approach following mastectomy.
METHODS: This retrospective single-center cohort included consecutive patients undergoing immediate implant-based breast reconstruction within a standardized onco-aesthetic framework. Surgical planning incorporated individualized skin-envelope management, implant selection, and selective contralateral symmetrization. Patient-reported outcomes were assessed using the BREAST-Q Reconstruction Module, while aesthetic results were independently evaluated using the Harris photographic scale. Bilateral aesthetic outcomes and postoperative complications were also analyzed.
RESULTS: Fifty-six patients were included; 24 (42.9%) underwent immediate contralateral symmetrization. Significant improvements were observed in BREAST-Q Satisfaction with Breasts (+ 34.9 points), Psychosocial Well-being (+ 20.7), Sexual Well-being (+ 33.5), and Physical Well-being: Chest (+ 19.0) (all P < .001) Good-to-excellent physician-rated aesthetic outcomes were achieved in 35/56 patients (62.5%), and Harris aesthetic quality strongly correlated with postoperative Satisfaction with Breasts (Spearman's ρ = 0.904, P < .001) Contralateral symmetrization was not independently associated with postoperative satisfaction after accounting for achieved aesthetic quality. Postoperative complications occurred in 12/56 patients (21.4%), with implant removal in 3/56 (5.4%) and implant retention of 94.6%.
CONCLUSIONS: An integrated onco-aesthetic approach was associated with substantial improvements in patient-reported outcomes, favorable aesthetic results, and high implant retention. Patient satisfaction was more closely related to achieved aesthetic quality than to contralateral symmetrization itself, supporting individualized bilateral reconstructive planning.