Plastic and Reconstructive Surgery

Skip Navigation LinksHome > July 2009 - Volume 124 - Issue 1 > Patient-Reported Aesthetic Satisfaction with Breast Reconstr...
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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3181ab10b2
Breast: Original Articles

Patient-Reported Aesthetic Satisfaction with Breast Reconstruction during the Long-Term Survivorship Period

Hu, Emily S. M.D.; Pusic, Andrea L. M.D.; Waljee, Jennifer F. M.D., M.P.H.; Kuhn, Latoya M.P.H.; Hawley, Sarah T. Ph.D.; Wilkins, Edwin M.D.; Alderman, Amy K. M.D., M.P.H.

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Background: Expander/implant and autogenous tissue breast reconstructions have different aging processes, and the time when these processes stabilize is unclear. The authors' goal was to evaluate long-term patient-reported aesthetic satisfaction with expander/implant and autogenous breast reconstruction.

Methods: The authors surveyed a cross-section of University of Michigan women who underwent postmastectomy breast reconstruction (response rate, 73 percent) between 1988 and 2006 [110 expander/implant and 109 transverse rectus abdominis myocutaneous (TRAM) reconstructions]. Each group was stratified into three postreconstructive periods: short term (≤5 years), intermediate (6 to 8 years), and long term (>8 years). Validated satisfaction items were scored on a 5-point Likert scale; scores were dichotomized into positive and negative responses. Logistic regression assessed satisfaction by procedure, while controlling for sociodemographic and clinical variables.

Results: Mean follow-up time after reconstruction was 6.5 years (range, 1 to 18 years). Procedure type had no effect on short-term aesthetic satisfaction. However, in the long term, reconstruction type considerably affected satisfaction. Although satisfaction with TRAM reconstruction remained relatively constant, satisfaction with expander/implants was significantly less among those patients in the long term. Patients who had undergone implant reconstruction more than 8 years earlier, compared with those who undergone implant reconstruction less than 5 years earlier, were significantly less satisfied with breast appearance (odds ratio, 0.10; 95% CI, 0.02 to 0.48), softness (odds ratio, 0.14; 95% CI, 0.03 to 0.64), and size (odds ratio, 0.13; 95% CI, 0.03 to 0.62).

Conclusions: In the long term, TRAM patients, compared with expander/implant patients, appear to have significantly greater aesthetic satisfaction. These long-term data have important implications for women's health in the survivorship period and will help women navigate the complex decision-making process of breast reconstruction.

©2009American Society of Plastic Surgeons


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