Background:
Autologous breast reconstruction has continued to increase in popularity and witnessed significant advancements in aesthetic outcomes, patient satisfaction, and improved quality of life. We performed the first bibliometric analysis focused only on the 100 most-cited autologous breast reconstruction articles to characterize any emerging trends and assess the methodological quality of these studies.

Methods:
The 100 most-cited articles in autologous breast reconstruction were identified on Web of Science, across all available journals and years. Study details, including the citation count, main subject, and outcome measures, were extracted from each article, and the level of evidence was also assessed.

Results:
The 100 most-cited articles in autologous breast reconstruction were cited by a total of 21,194 articles. Citation per article ranged significantly from 112 to 1123 (mean, 211.9). Overall, most of the top-cited articles are case reports/series (n = 32, mean citations = 243.2) and cohort studies (n = 30, mean citations = 211.2). This is closely followed by case-control studies (n = 29, mean citations = 183.6). Only four studies achieved level 1 status, underscoring a lack of high-quality methodological research in the field. Most studies (n = 72) highlighted autologous breast reconstruction outcomes, whereas 12 focused on its indications. There were nine studies exploring surgical techniques, and seven studies addressing the autologous breast reconstruction surgical anatomy.

Conclusions:
Overall, most of the influential articles in autologous breast reconstruction literature are of lower-level evidence. Contemporary research should focus on enhancing the study designs and measure clinical and patient-reported outcomes with validated tools, such as BREAST-Q.