Fredrik Brorson: Breast reconstruction – methods and long-term outcomes

Image

FREDRIK BRORSON
Dissertation defense: 27 February 2026 (click for details)
Doctoral thesis: GoBreast I: A randomized controlled trial in delayed breast reconstruction after cancer
Research area: Plastic Surgery
Sahlgrenska Academy, The Institute of Clinical Sciences

Removal of the entire breast can lead to physical imbalance, practical challenges in daily life, and changes in body image that affect self-esteem. Reconstructing the breast can improve symmetry and physical functioning, and it often contributes to psychological coping.

“By reconstructing the breast, we can restore balance across the chest and support psychological recovery,” says Fredrik Brorson, specialist in plastic surgery and surgery at Sahlgrenska University Hospital and doctoral student at the Institute of Clinical Sciences.

Four reconstruction methods compared

The thesis examines four different approaches to breast reconstruction after mastectomy: implant-only reconstruction, combinations of implants and autologous tissue, and methods based entirely on the patient’s own tissue.

Three prospective randomized clinical studies were conducted, involving 191 women. In the studies, participants were randomly assigned to one of two reconstruction methods, with the two methods compared determined by whether they had previously received radiotherapy. 

“All methods are safe, but the type and severity of complications vary. Women who have received radiotherapy require more extensive surgery to compensate for radiation-related effects and therefore experience a greater burden of complications.”

Quality of life and costs

At follow-up several years after surgery, women generally reported better quality of life than before reconstruction. Differences between methods were small among women who had not received radiotherapy. Among women who had been irradiated, reconstruction using autologous tissue appeared to provide the greatest long-term satisfaction, although the number of patients in this group was limited.

“It was not possible to quantify how much the reconstruction contributed compared with other life events. It’s likely that both contribute to aspects of improvement,” says Fredrik Brorson.

Health economic analyses showed that autologous tissue reconstruction was more cost-effective than combined methods in women who had received radiotherapy. In women who had not received radiotherapy, a two-stage procedure using a tissue expander followed by an implant was the more cost-effective option.

Image

More than half last 20 years

A fourth sub-study followed long-term outcomes in 600 women who underwent implant-based breast reconstruction. A majority of the women (57%) retained their original implant after 20 years. The others had needed at least one additional procedure to maintain their reconstruction.

“However, some methods showed poorer long-term outcomes than others. One technique that is no longer used in Sweden – direct-to-implant reconstruction – performed worse than the other methods.”

The most common long-term complication was scar tissue formation around the implant, known as capsular contracture. This often requires additional surgery and can recur. For some women, it leads to several further procedures.

Results guide clinical care

The findings from the studies are currently used to develop postoperative care and to support discussions between patients and surgeons when choosing a reconstruction method.

What has been the most rewarding and most challenging part of your doctoral project?
“Conducting prospective randomized clinical studies is highly demanding but also very educational. Over time, clear patterns emerged that could be analyzed, and it has been stimulating to learn new research methods. The work has sparked curiosity, both about how clinical studies are designed and about how reliable the knowledge we can generate in the surgical field actually is.”

Text: Jakob Lundberg