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Patient Satisfaction and Health-Related Quality of Life following Breast Reconstruction: Patient-Reported Outcomes among Saline and Silicone Implant Recipients

Macadam, Sheina A. M.S.; Ho, Adelyn L. M.D.; Cook, E. F. Jr S.D.; Lennox, Peter A. M.D.; Pusic, Andrea L. M.H.S.

Plastic & Reconstructive Surgery: March 2010 - Volume 125 - Issue 3 - pp 761-771
doi: 10.1097/PRS.0b013e3181cb5cf8
Breast: Outcomes Article

Background: In recent years, there has been a growing acceptance of the value of breast reconstruction. The majority of women who choose to proceed will undergo alloplastic reconstruction. The primary objective of this study was to determine whether the type of implant used in alloplastic breast reconstruction has an impact on patient-reported satisfaction and quality of life.

Methods: Patients were deemed eligible if they had completed alloplastic reconstruction at least 1 year before study initiation. Patients were contacted by mail: two questionnaires [the BREAST-Q and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (Br23) (EORTC QLQC30 (Br23))], a contact letter, and an incentive gift card were included. Scores were compared between silicone and saline implant recipients.

Results: Seventy-five silicone implant recipients and 68 saline implant recipients responded, for a response rate of 58 percent. BREAST-Q responses showed silicone implant recipients to have higher scores on all nine subscales. This difference reached statistical significance on four of nine subscales: overall satisfaction (p = 0.008), psychological well-being (p = 0.032), sexual well-being (p = 0.05), and satisfaction with surgeon (p = 0.019). Regression analysis adjusted for follow-up time, timing of surgery, unilateral versus bilateral surgery, radiation, and age. Results from the EORTC QLQC30 (Br23) showed a statistically significant difference on two of 22 subscales: silicone recipients had higher overall physical function, and saline recipients had higher systemic side effects.

Conclusions: This study has shown higher satisfaction with breast reconstruction in silicone gel implant recipients compared with saline recipients using the BREAST-Q. There was no difference in overall global health status between the two patient groups as measured by the EORTC-QLQC30 (Br23).

Vancouver, British Columbia, Canada; Boston, Mass.; and New York, N.Y.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia; Department of Epidemiology, Harvard School of Public Health; and Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center.

Received for publication May 24, 2009; accepted September 4, 2009.

Presented at the Podium Presentation at the 63rd Annual Meeting of the Canadian Society of Plastic Surgeons, in Kelowna, British Columbia, Canada, June 16 through 20, 2009.

Disclosures: This study was funded by the 2008 University of British Columbia Concept Award. The BREAST-Q is jointly owned by Memorial Sloan-Kettering Cancer Center and the University of British Columbia. Dr. Pusic is a co-developer of the BREAST-Q and, as such, receives a share of any license revenues based on the inventor sharing policies of these two institutions.

Sheina A. Macadam, M.S., Plastic and Reconstructive Surgery, University of British Columbia, 777 West Broadway, Suite 1000, Vancouver, British Columbia V5Z 4J7 Canada, drsmacadam@gmail.com

©2010American Society of Plastic Surgeons