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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.

Plastic and Reconstructive Surgery: July 2009 - Volume 124 - Issue 1 - p 1-8
doi: 10.1097/PRS.0b013e3181ab10b2
Breast: Original Articles

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.

Ann Arbor, Mich.; and New York, N.Y.

From the Section of Plastic Surgery, Department of Surgery, the Robert Wood Johnson Clinical Scholars Program and the Department of Surgery, and the Division of General Medicine, Department of Internal Medicine, The University of Michigan Medical Center; the Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center; and the Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Care System.

Received for publication May 15, 2008; accepted August 21, 2008.

Disclosure: This work was supported by the Robert Wood Johnson Foundation. None of the authors has a financial interest in any of the products or devices mentioned in the article.

Amy K. Alderman, M.D., M.P.H.; Section of Plastic and Reconstructive Surgery; Department of Surgery; University of Michigan; 2130 Taubman Center; 1500 E. Medical Center Drive; Ann Arbor, Mich. 48109-0340;

©2009American Society of Plastic Surgeons