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Prospective Analysis of Long-term Psychosocial Outcomes in Breast Reconstruction: Two-year Postoperative Results From the Michigan Breast Reconstruction Outcomes Study

Atisha, Dunya MD*†; Alderman, Amy K. MD, MPH*‡; Lowery, Julie C. PhD; Kuhn, Latoya E. MPH; Davis, Jenny MHSA; Wilkins, Edwin G. MD, MS*

doi: 10.1097/SLA.0b013e3181728a5c
Original Articles

Objective: To prospectively evaluate the psychosocial outcomes and body image of patients 2 years postmastectomy reconstruction using a multicenter, multisurgeon approach.

Background: Although breast reconstruction has been shown to confer significant psychosocial benefits in breast cancer patients at year 1 postreconstruction, we considered the possibility that psychosocial outcomes may remain in a state of flux for years after surgery.

Methods: Patients were recruited as part of the Michigan Breast Reconstruction Outcome Study, a 12 center, 23 surgeon prospective cohort study of mastectomy reconstruction patients. Two-sided paired sample t tests were used to compare change scores for the various psychosocial subscales. Multiple regression analysis was used to determine whether the magnitude of the change score varied by procedure type.

Results: Preoperative and postoperative year 2 surveys were received from 173 patients; 116 with immediate and 57 with delayed reconstruction. For the immediate reconstruction cohort, significant improvements were observed in all psychosocial subscales except for body image. This occurred essentially independent of procedure type. In the cohort with delayed reconstruction, significant change scores were observed only in body image. Women with transverse rectus abdominis musculocutaneous flaps had significantly greater gains in body image scores (P = 0.003 and P = 0.034, respectively) when compared with expander/implants.

Conclusions: General psychosocial benefits and body image gains continued to manifest at 2 years postmastectomy reconstruction. In addition, procedure type had a surprisingly limited effect on psychosocial well being. With outcomes evolving beyond year 1, these data support the need for additional longitudinal breast reconstruction outcome studies.

We prospectively evaluated the psychosocial outcomes of breast cancer patients 2 years post-transverse rectus abdominis musculocutaneous flap or expander/implant breast reconstruction using a multicenter approach. We found that psychosocial benefits and body image gains continued to manifest at 2 years. In addition, procedure type had a surprisingly limited effect on psychosocial outcomes.

From the *Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical Center; †Department of Surgery, St. Joseph Mercy Hospital; and ‡VA Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, MI.

Reprints: Edwin Wilkins, MD, MS, Department of Surgery, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0340. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.