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Patient Satisfaction in Postmastectomy Breast Reconstruction: A Comparative Evaluation of DIEP, TRAM, Latissimus Flap, and Implant Techniques

Yueh, Janet H. M.D.; Slavin, Sumner A. M.D.; Adesiyun, Tolulope B.A.; Nyame, Theodore T. M.D.; Gautam, Shiva Ph.D.; Morris, Donald J. M.D.; Tobias, Adam M. M.D.; Lee, Bernard T. M.D.

Plastic and Reconstructive Surgery: June 2010 - Volume 125 - Issue 6 - p 1585-1595
doi: 10.1097/PRS.0b013e3181cb6351
Breast: Outcomes Article

Background: Despite a growing literature on patient satisfaction in breast reconstruction, few studies have compared perforator flaps with the more commonly practiced methods. The authors compared four reconstructive techniques and identified factors influencing patient satisfaction.

Methods: All patients undergoing postmastectomy breast reconstruction between 1999 and 2006 at a single academic institution were included in our study. A total of 583 patients with tissue expander/implant, latissimus, pedicle transverse rectus abdominis muscle (TRAM), and deep inferior epigastric perforator (DIEP) flap reconstructions received a validated questionnaire on satisfaction, health-related quality of life, and sociodemographic data.

Results: Patient response was 75 percent, with 439 completed questionnaires including 87 tissue expander/implant, 116 latissimus, and 119 pedicle TRAM and 117 DIEP flap patients. DIEP patients had the highest level of general satisfaction at 80 percent, and pedicle TRAM patients had the highest level of aesthetic satisfaction at 77 percent (p < 0.001 and p < 0.001, respectively). Health-related quality of life and length of time since surgery were identified as significant covariates influencing patient satisfaction. After logistic regression analysis, autologous reconstruction had significantly higher general and aesthetic satisfaction than implant-based reconstruction (p = 0.017 and p < 0.001). Among the autologous reconstructions, abdominal-based flaps had significantly higher general and aesthetic satisfaction than latissimus flaps (p = 0.011 and p = 0.016). When comparing the abdominal-based reconstructions, general and aesthetic satisfaction were no longer statistically significant between pedicle TRAM and DIEP flaps (p = 0.659 and p = 0.198).

Conclusions: Autologous, abdominal-based reconstructions had the highest satisfaction rates across all four groups. After logistic regression analysis, differences in patient satisfaction between pedicle TRAM and DIEP flap reconstruction were no longer observed. Discussing satisfaction outcomes with patients will help them make educated decisions about breast reconstruction.


Boston, Mass.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Biostatistics Program, Harvard-Thorndike General Clinical Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School.

Received for publication March 1, 2009; accepted September 15, 2009.

Presented at Plastic Surgery 2008: The Annual Meeting of the American Society of Plastic Surgeons, in Chicago, Illinois, October 31 through November 5, 2008.

Disclosure: This research was performed with sponsorship from the Doris Duke Charitable Foundation (to J.H.Y.) and the Peter Jay Sharp Foundation (to T.A., A.M.T., and B.T.L.). None of the authors has a financial interest in any of the products or devices mentioned in this article.

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Bernard T. Lee, M.D.; Department of Surgery; Division of Plastic and Reconstructive Surgery; Beth Israel Deaconess Medical Center; 110 Francis Street, Suite 5A; Boston, Mass. 02215;

©2010American Society of Plastic Surgeons