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Maxi von Glinski, Nikla Holler, Sherko Kümmel, Mattea Reinisch, Christoph Wallner, Johannes Maximilian Wagner, Mehran Dadras, Alexander Klaus Sogorski, Marcus Lehnhardt, Björn Behr

• \(\bf Introduction:\) Autologous (ABR) and implant-based breast reconstruction (IBR) represent the most common procedures after skin- and nipple-sparing mastectomy. This cross-sectional study is a comprehensive analysis of ABR and IBR considering surgical and patient-reported outcomes. \(\textbf {Patients and methods:}\) Eligible patients underwent breast reconstruction (ABR and IBR) after skin- and nipple-sparing mastectomy between January 2014 and December 2020. Outcome parameters included quality of life (European Organisation for Research and Treatment of Cancer - EORTC - QLQ30, BR23, Breast-Q, CES-D), complication rates, aesthetic result, and breast sensitivity. \(\bf Results:\) 108 patients participated in the study (IBR: \(\it n\) = 72, age 48.9 \(\pm\) 9.9 years; ABR: \(\it n\) = 36, age: 46.6 \(\pm\) 7.3 years). Mean follow-up was 27.1 \(\pm\) 9.3 (IBR) and 34.9 \(\pm\) 20.5 (ABR), respectively. IBR patients suffered significantly more often from major complications (30.6% vs. 8.3%; \(\it p\) = 0.01), while ABR patients underwent secondary procedures significantly more often to improve the aesthetic result (55.6% vs. 29.2%, \(\it p\) = 0.004). Unilateral reconstructions revealed superior aesthetic results in ABR (n.s.), while in bilateral reconstruction IBR tended to score higher (n.s.). Scar evaluation resulted in a better result of IBR in both categories (\(\it p\) < 0.01). Breast sensitivity was severely impaired in both groups. The Breast-Q revealed a significantly higher "patient satisfaction with breast" after ABR (\(\it p\) = 0.033), while the other QoL-tests and subscales showed no significant differences between the two procedures. \(\bf Conclusion:\) ABR is associated with a higher patient satisfaction despite the high probability of secondary procedures to improve the aesthetic outcome, whereas IBR-patients suffer more often from major complications. Furthermore, the laterality of reconstruction should be included in the individual decision-making process.