PRS AAPS Oral Proofs 2016
Andrea L. Pusic, MD, MHS,* Hyungin Myra Kim, ScD,† Jennifer B. Hamill, MPH,‡ Ji Qi, MS,‡ Edwin G. Wilkins, MD, MS‡
From the *Memorial Sloan-Kettering Cancer Center, New York, N.Y.; †Department of Biostatistics, University of Michigan, Ann Arbor, Mich.; and ‡Section of Plastic Surgery, University of Michigan, Ann Arbor, Mich.
PURPOSE: The goal of postmastectomy reconstruction is to minimize deformity and optimize quality of life as perceived by the patient. This study prospectively evaluates patient-reported outcomes for breast reconstruction patients.
METHODS: Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction after mastectomy. Procedures included implant-based latissimus dorsi, pedicle TRAM, free TRAM, and DIEP reconstructions. Patients completed the BREAST-Q and PROMIS-29 preoperatively and at 1 year postsurgery. For each outcome, separate linear mixed-effects models were used to test for within-patient 1-year outcomes and to compare outcomes across procedure types. Both models were weighted for nonresponse and used site as random intercepts, and the latter was adjusted for baseline covariates.
RESULTS: One thousand five hundred fifty-two Mastectomy Reconstruction Outcomes Consortium patients were included, and 1130 (73%) responded to 1-year questionnaires. Across procedure types, immediate reconstruction patients experienced satisfaction with their breasts and psychosocial well-being equal to or better than preoperative status. Physical well-being of the chest was not fully restored (P < 0.001 implant patients; P = 0.02 autologous), nor was physical well-being of the abdomen for autologous patients (P < 0.001). Autologous patients reported greater satisfaction with their breasts compared to implant patients, adjusting for covariates (P < 0.001).
CONCLUSIONS: One year after surgery, patients experience satisfaction with their breasts equal to or greater than their preoperative status; physical well-being, however, is not fully restored. Patients who choose autologous reconstruction are more satisfied with their breasts than implant patients.