PRS AAPS Oral Proofs 2016
Eliana F.R. Duraes, MD,* Todd Baker, MD,* Megan Morisada, BA,† Susan Orra, BA,† Mona Ascha, BA,† Joao Batista de Sousa, MD, PhD,‡ Risal S. Djohan, MD,* Steven Bernard, MD,* Graham S. Schwarz, MD,* Andrea A. Moreira, MD*
From the *Cleveland Clinic, Cleveland, Ohio; †Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; and ‡University of Brasilia, Brasilia, Brazil.
PURPOSE: This study aims to establish factors influencing aesthetic outcomes and patient-reported quality of life after breast reconstruction.
METHODS: From 2009 to 2011, patients who underwent any type of reconstruction received postoperative BreastQ3 questionnaires. Answers were compared according to patient and surgical related factors influencing breast-related quality of life. Postoperative photographs from patients who answered the questionnaire were graded by a 6-member blinded panel with a multiparameter breast-specific scale (scored 1–5).
RESULTS: Two hundred sixty-one of 820 patients answered the questionnaires. Median length of follow-up was 48 (38–60) months. Satisfaction with breasts was higher in autologous reconstruction (ABR; P < 0.05), bilateral reconstructions (BiRs; P < 0.01), and patients with body mass index (BMI; 25–29.9 vs >30 kg/m2; P < 0.05). Sexual well-being was higher in patients with nipples either preserved or reconstructed (P < 0.05). Radiation therapy (RT) was associated with lower satisfaction with outcome (P < 0.05) and physical well-being (P < 0.01). Psychosocial well-being was higher without RT (P < 0.01), and BMI was 25 to 29.9 versus >30 kg/m2 (P < 0.01). One hundred forty-seven postoperative photographs were evaluated. Superior aesthetic outcomes were observed for ABR versus implant-based reconstructions, no-RT versus RT, and BiR versus unilateral. There was a correlation between the aesthetic outcome and patient satisfaction with breasts (r = 0.32, P < 0.001).
CONCLUSIONS: Overall, patient satisfaction with breasts and aesthetic outcomes are highest with ABR, BiR, and without RT. The presence of lower BMI and nipple reconstruction positively influence satisfaction. An aesthetically pleasant breast does not guarantee patient satisfaction.