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Original Investigation
October 2018

Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Author Affiliations
  • 1Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
  • 2Center for Statistical Consultation and Research, University of Michigan, Ann Arbor
  • 3Department of Biostatistics, University of Michigan, Ann Arbor
  • 4Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
  • 5now with the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham Health, Boston, Massachusetts
JAMA Surg. 2018;153(10):891-899. doi:10.1001/jamasurg.2018.1677
Key Points

Question  How do satisfaction and breast-related quality of life differ between patients undergoing implant-based vs autologous immediate breast reconstruction at 2 years after surgery?

Findings  In this multicenter cohort study, patients who underwent autologous reconstruction reported significantly greater satisfaction with their breasts (BREAST-Q score difference, 7.94), psychosocial well-being (difference, 3.23), and sexual well-being (difference, 5.53) at 2 years compared with patients who underwent implant reconstruction.

Meaning  At 2 years after reconstruction, patients who underwent autologous reconstruction reported significantly greater satisfaction and breast-related quality of life compared with patients who underwent implant-based techniques.

Abstract

Importance  Previous outcome studies comparing implant and autologous breast reconstruction techniques have been limited by short-term follow-up, single-center design, and a lack of rigorous patient-reported outcome data. An understanding of the expected satisfaction and breast-related quality of life associated with each type of procedure is central to the decision-making process.

Objective  To determine outcomes reported by patients undergoing postmastectomy breast reconstruction using implant or autologous techniques 2 years after surgery.

Design, Setting, and Participants  Patients were recruited from 11 centers (57 plastic surgeons) across North America for the Mastectomy Reconstruction Outcomes Consortium study, a prospective, multicenter trial, from February 1, 2012, to July 31, 2015. Women undergoing immediate breast reconstruction using implant or autologous tissue reconstruction after mastectomy for cancer treatment or prophylaxis were eligible. Overall, 2013 women (1490 implant and 523 autologous tissue reconstruction) met the inclusion criteria. All patients included in this analysis had 2 years of follow-up.

Exposures  Procedure type (ie, implant vs autologous tissue reconstruction).

Main Outcomes and Measures  The primary outcomes of interest were scores on the BREAST-Q, a validated, condition-specific, patient-reported outcome instrument, which were collected prior to and at 2 years after surgery. The following 4 domains of the BREAST-Q reconstruction module were evaluated: satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being. Responses from each scale were summed and transformed on a 0 to 100 scale, with higher numbers representing greater satisfaction or quality of life.

Results  Of the 2013 women in the study (mean [SD] age, 48.1 [10.5] years for the group that underwent implant-based reconstruction and 51.6 [8.7] years for the group that underwent autologous reconstruction), 1217 (60.5%) completed questionnaires at 2 years after reconstruction. After controlling for baseline patient characteristics, patients who underwent autologous reconstruction had greater satisfaction with their breasts (difference, 7.94; 95% CI, 5.68-10.20; P < .001), psychosocial well-being (difference, 3.27; 95% CI, 1.25-5.29; P = .002), and sexual well-being (difference, 5.53; 95% CI, 2.95-8.11; P < .001) at 2 years compared with patients who underwent implant reconstruction.

Conclusions and Relevance  At 2 years, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial well-being and sexual well-being than did those who underwent implant reconstruction. These findings can inform patients and their clinicians about expected satisfaction and quality of life outcomes of autologous vs implant-based procedures and further support the adoption of shared decision making in clinical practice.

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