Patient-reported outcomes following various incision techniques in breast reconstruction: an observational cohort study in China

To evaluate patient satisfaction with different incision types in breast reconstruction surgery in China and to explore the factors related to these outcomes.

This single-center, retrospective cohort study included patients who underwent breast reconstruction at Hubei Cancer Hospital from September 2022 to September 2024. The patients were divided into four groups based on the incision type: (1) lateral axillary incision, (2) radial incision, (3) inferolateral inframammary fold incision, and (4) endoscopic-assisted surgery. Patient-reported outcomes (PROs) were collected ≥ 3 months after surgery using the Breast Cancer Core Scale (BREAST-Q) V2.0, the EuroQol five-dimension five-level health questionnaire (EQ-5D-5L), and the Decision Regret Scale (DRS). It should be noted that the type of incision was non-randomly allocated, although multivariate regression was performed to adjust for potential confounding factors.

A total of 209 patients were included in this study. 34 (16.3%), 67 (32.1%), 64 (30.6%), and 44 (21.1%) patients underwent lateral axillary incision, radial incision, inferolateral inframammary fold incision, and endoscopic-assisted surgery, respectively. The endoscopic-assisted surgery group had the highest satisfaction (59.00 [IQR 57.75, 65.00]), and the radial incision group had the lowest satisfaction (53.00 [IQR 47.00-60.50]) (P = 0.007). Multivariable linear regression showed that a reduction in bra size was negatively independently associated with breast satisfaction (β = − 18.662, 95%CI: −26.789, −10.535, P < 0.001), while an inferolateral inframammary fold incision was positively independently associated with breast satisfaction (β = 6.430, 95%CI: 0.199, 12.662, P = 0.043). Skin-sparing mastectomy (SSM) (β = 7.468, 95%CI: 0.557–14.308, P = 0.034) and prepectoral implant plane (β = 6.756, 95%CI: 0.278–13.234, P = 0.041) were both positively independently associated with the DRS scores.

Despite the study’s limitations, our findings indicate that traditional techniques such as radial incision and inferolateral inframammary fold incision are still prevalent in China. Endoscopic-assisted surgery is associated with superior patient-reported satisfaction, highlighting its potential value for wider dissemination in clinical practice. Factors influencing patient satisfaction include reduced bra cup size, surgical approach, and implant plane.