Indications and Outcomes of Autologous Conversion from Implant-Based Breast Reconstruction

Abstract

Background

In this study, we explored the transition from implant-based to autologous breast reconstruction, focusing on the factors prompting conversion, patient outcomes, and the role of emerging flap types such as profunda artery perforator (PAP) and lumbar artery perforator (LAP) in reconstruction choices. Historically, implant-based methods dominated breast reconstruction, but limitations and complications have led a subset of patients to prefer autologous reconstruction, especially after radiation therapy. This research aimed to elucidate the decision-making process behind switching to autologous methods, examining a broad range of patient demographics and conversion factors.

Methods

A retrospective review was conducted using REDCap database information from January 2012 to August 2023, including 119 patients who converted from implant-based to autologous reconstruction and 1,329 who underwent primary autologous reconstruction. Data analysis covered demographics, comorbidities, reasons for conversion, types of surgeries performed, and BREAST-Q responses to assess satisfaction and quality of life.

Results

Indications for conversion included capsular contracture, dissatisfaction, and complications from previous treatments. Patients undergoing autologous conversion typically experienced more revision surgeries compared with those with primary autologous reconstruction. Notably, emerging flap options like PAP and LAP were more frequently utilized in conversions. BREAST-Q scores showed no significant preoperative differences, but postoperative satisfaction varied, highlighting the nuanced outcomes of reconstruction choices.

Conclusion

In conclusion, converting to autologous breast reconstruction offers a patient-centered alternative for those facing implant-based reconstruction failures, underscoring the need for individualized surgical approaches. This study contributes valuable insights into optimizing reconstructive outcomes by understanding patient preferences and advancements in flap techniques.

Keywords

autologous conversion - breast reconstruction - implant reconstruction failure

Publication History

Received: 29 April 2025

Accepted: 21 September 2025

Accepted Manuscript online:
10 October 2025

Article published online:
27 October 2025

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