Real-world quality of life outcomes after prepectoral implant-based breast reconstruction with or without titanium-coated mesh (TiLOOP® Bra Pocket): A prospective cohort study.

Abstract

<h4>Purpose</h4>To evaluate quality of life (QoL) one year after immediate prepectoral direct-to-implant breast reconstruction (DTIBR) with and without a titanium-coated mesh (TiLOOP® Bra Pocket).<h4>Methods</h4>In this prospective study (March 2021-February 2024), 309 DTIBR patients were analyzed. QoL was assessed preoperatively and postoperatively using the Breast-Q questionnaire (psychosocial well-being, sexual well-being, satisfaction with breasts, and physical well-being of the chest). Influencing factors were identified via linear regression.<h4>Results</h4>One-year follow-up (FUP) included 235 unilateral (85.8 %) and 31 bilateral (92.2 %, 61 breasts) DTIBR cases. After excluding 14 patients (autologous reconstruction, ADM use, or both prior and additional postoperative RT), 282 remained: 203 (71.7 %) with TiLOOP® Bra Pocket, 61 (21.9 %) without implant coverage, and 18 (6.4 %) using "dual-plane" techniques. Mean scores showed increased psychosocial well-being (71.2-73.9) but declines in sexual well-being (64.3-60.3), satisfaction with breasts (67.3-65.2), and chest-related physical well-being (83.1-76.4). Higher preoperative scores predicted postoperative declines across all QoL domains. Older age correlated with better psychosocial (B = 0.189, p = 0.032) and physical well-being (B = 0.259, p = 0.008). TiLOOP® Bra Pocket improved psychosocial well-being (B = 4.971, p = 0.038). Satisfaction with breasts was lower with pending symmetrizing procedures (B = -13.771, p < 0.001) or complications (B = -6.543, p = 0.049). Postoperative RT reduced physical well-being (B = -7.309, p = 0.008).<h4>Conclusion</h4>DTIBR results in high QoL, influenced by complications, postoperative RT, age, and preoperative satisfaction. Patients should be counseled considering these factors.