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A Retrospective Analysis of Outcomes Using Three Common Methods for Immediate Breast Reconstruction

Spear, Scott L. M.D.; Newman, Michael K. M.D.; Bedford, M Susann M.D.; Schwartz, Karl A. M.D.; Cohen, Michael M.D.; Schwartz, Jaime S. M.D.

Plastic and Reconstructive Surgery: August 2008 - Volume 122 - Issue 2 - p 340-347
doi: 10.1097/PRS.0b013e31817d6009
Breast: Original Articles

Background: Breast reconstruction outcome studies typically evaluate satisfaction, complications, or aesthetic results. Some studies report better outcomes with autologous reconstruction, whereas other studies report no difference in outcomes across multiple reconstructive methods.

Methods: The authors retrospectively studied all patients undergoing immediate breast reconstruction over a 5-year period. Questionnaires were sent to all patients to assess satisfaction; preoperative bra size, height, and weight; smoking history; radiation history; length of stay; narcotic use; and recovery time. All charts were reviewed for complications. Four blinded reviewers performed aesthetic evaluations of patient results.

Results: One hundred eighty-six consecutive immediate breast reconstruction patients were surveyed. Charts and photographs were reviewed for complication data and aesthetic results. The survey response rate was 42 percent, including 48 of 106 expander/implant patients, 13 of 28 latissimus patients, and 18 of 52 transverse rectus abdominis musculocutaneus (TRAM) flap patients. Patient satisfaction was rated as moderate or better for 93.8 percent of the expander/implant patients, 76.9 percent of the latissimus flap patients, and 83.3 percent of the TRAM flap patients. Expander/implant patients were significantly more satisfied than latissimus flap patients. Complication rates were 21.7 percent for expander/implant patients, 67.9 percent for latissimus flap patients, and 26.9 percent for TRAM flap patients. Reoperation rates were 11.3 percent for expander/implant patients, 10.7 percent for latissimus flap patients, and 5.8 percent for TRAM flap patients. Aesthetic scores were significantly higher for TRAM flap patients compared with expander/implant and latissimus flap patients.

Conclusion: High satisfaction rates were seen across all three reconstructive groups, with the highest satisfaction levels seen in the expander/implant group, despite higher reoperation rates and lower aesthetic scores for this group.

Washington, D.C.

From the Department of Plastic Surgery, Georgetown University Hospital.

Received for publication June 20, 2007; accepted December 14, 2007.

Disclosure: Dr. Spear is a paid consultant for LifeCell, Allergan, and Ethicon. Drs. Newman, Bedford, Schwartz, and Cohen have no disclosures.

Scott L. Spear, M.D., Georgetown University Hospital, 3800 Reservoir Road, N.W., 1st Floor, PHC Building, Washington, D.C. 20007, spears@gunet.georgetown.edu

©2008American Society of Plastic Surgeons