Long-term study to assess quality of life and cost outcomes of different delayed breast reconstruction techniques: A randomized controlled trial (GoBreast)
In brief
Expander reconstruction boosts quality of life and cuts re-operations by half
In a 13-year follow-up of women without prior radiotherapy, a two-stage tissue expander yielded a 0.06 increase in health-related quality-of-life utility and required about 2.3 surgeries versus 4.7 with a thoracodorsal flap. For irradiated patients, DIEP flaps matched costs but required fewer repeat surgeries than latissimus dorsi flaps, suggesting procedure choice should consider prior radiation status.
- Journal
- Scandinavian Journal of Surgery (Q1)
- Published
- 30 June 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Fredrik Brorson, Emma Hansson, Anna Paganini, Anna Elander, Mikael Svensson
- PMID
- 42376772
- DOI
- 10.1177/14574969261462051
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (top studies of the week, 11 October 2026): EXP yields superior HRQoL and fewer re-operations
Abstract
BACKGROUND: The aim of breast reconstruction after mastectomy is to improve quality of life and patient satisfaction, but cost-effectiveness of different reconstruction techniques remains uncertain due to methodological limitations in existing studies. High-quality trial-based economic evaluations are therefore needed. This study aimed to compare the quality of life and cost outcomes of patients randomized to different delayed breast reconstruction techniques based on previous receipt of radiotherapy. METHODS: A single-site randomized controlled trial (GoBreast; NCT03963427) including women aged 18-60 undergoing delayed breast reconstruction was conducted. Patients without previous radiotherapy were randomized to either thoracodorsal flap with implant (TD) or two-stage expander (EXP), while patients with previous receipt of radiotherapy were randomized to either latissimus dorsi with implant (LD) or deep inferior epigastric artery perforator (DIEP) flap. Outcomes included health-related quality of life (HRQoL) (by SF-6D utilities), re-operations, and direct/indirect costs over long-term follow-up. RESULTS: Among patients without previous radiotherapy (n = 75), EXP had slightly lower direct healthcare costs, but higher indirect costs, and generated a statistically significant positive change in HRQoL utility value (0.06 (0.02;0.9)) and fewer re-operations (2.34 vs 4.73) during a mean follow-up of 12.9 years. Among patients who had received radiotherapy (n = 25), there were no statistically significant differences in HRQoL utility scores or total costs, but a higher re-operation rate for LD as compared to DIEP. CONCLUSION: Among patients without previous radiotherapy, EXP yielded superior HRQoL and fewer re-operations compared to TD. In patients with previous receipt of radiotherapy, DIEP reconstruction was associated with fewer re-operations and comparable costs compared to LD.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.