Autologous reconstruction has proven to be a worthy alternative to implant-based reconstruction when considering patient satisfaction, long-term results, and complications, including implant failure or flap loss [12,16,17,18]. A study by Garvey et al. found that reconstruction by alloplastic methods results in higher failure rates compared to muscle or tissue flaps [16]. Additionally, the two approaches show no differences in outcome when comparing immediate reconstruction to delayed reconstruction with implant cases trending towards higher failure rates [16]. In a literature review spanning over 200 studies, Toyserkani et al. found that satisfaction rates were higher across studies for patients that received autologous-based breast reconstruction compared to implant-based reconstruction when evaluating psychosocial, sexual, and overall outcomes, further strengthening the rationale for presenting the option of autologous reconstruction to potential patients considering reconstruction post-mastectomy [17]. A study by von Glinski et al. reflected similar findings showing that autologous reconstruction not only presents with higher patient-reported satisfaction ratings but also greater aesthetic outcomes [18].

When studying complication rates among autologous breast reconstruction compared to implant-based reconstruction, many studies present varying rates of major and minor complications [18,19,20]. von Glinski et al. found that implant-based reconstruction resulted in a greater number of major complications—including implant malposition, major infection, capsular contracture, and need for revision surgery [18]. The same study found no significant difference in the incidence of minor complications—including hematoma, seroma, minor wound infections, and wound healing disorders—which have been seen in the previous literature to trend upwards in patients undergoing autologous breast reconstruction [18]. For instance, Bennet et al. with similar results did note a significant finding in minor complications among the implant-based versus autologous reconstruction showing that minor complications—including hematoma, seroma, minor wound infections, and wound healing disorders—were more common among autologous breast reconstruction [19]. Despite the increased occurrence rates, these minor complications rarely lead to flap loss in autologous reconstruction [18,19,20]. Major complications—as mentioned previously—were less often seen than minor complications in cases of autologous reconstruction and are more common among implant-based reconstruction [18,19,20]. The major complications are also more likely to lead to reconstruction failure requiring implant explantation for implant-based reconstruction [19,20]. So while autologous reconstruction carries a greater likelihood of minor complications, the complications usually require minor resolution and rarely lead to major revision surgery or flap failure. In contrast, implant-based reconstruction has fewer complications, though the complications that do arise are more likely to lead to revision surgery and explanation [18,19]. In addition, certain implant-based complications, such as rupture and capsular contractures, are not seen in autologous reconstruction [17,18]. Other major complications, such as infection, may necessitate more aggressive intervention for implant-based reconstruction—i.e., implant explantation and washout—that is not typically indicated for autologous reconstruction procedures as there is no foreign material [19]. As far as minor complications, results have shown comparable outcomes in terms of patient satisfaction after long-term studies, which revisits the position that either option is suitable for breast reconstruction [18].

Across studies, the patient-centered benefits of the use of autologous-based breast reconstruction have shown to be comparable and may at times surpass the expected overall outcomes and long-term satisfaction rates compared to implant-based reconstruction. Moreover, complications unique to implant-based use, such as Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), has made autologous reconstruction a more palatable option with less significant and life altering complications. Moreover, whether or not complications arise in implant-based reconstruction, the increased risk of implant failure over time and the need for implant replacement may require consideration for future surgical planning that is not necessary in autologous-based breast reconstruction. Finally, for certain patients, the allure of using their own tissue to reform their breast may be an additional factor that influences the decision towards autologous reconstruction which would be able to provide them with their desired outcomes and improved quality of life.