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Surgical Determinants of Patient-Reported Outcomes following Postmastectomy Reconstruction in Women with Breast Cancer

Jeevan, Ranjeet M.R.C.S.; Browne, John P. Ph.D.; Gulliver-Clarke, Carmel Ph.D.; Pereira, Jerome F.R.C.S.; Caddy, Christopher M. F.R.C.S.(Plast.); van der Meulen, Jan H. P. Ph.D.; Cromwell, David A. Ph.D.

Plastic and Reconstructive Surgery: May 2017 - Volume 139 - Issue 5 - p 1036e-1045e
doi: 10.1097/PRS.0000000000003236
Breast: Outcomes Articles
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Background: This national prospective cohort study compared the patient-reported outcomes of breast cancer patients undergoing postmastectomy autologous reconstruction to those who had breast implants, in terms of aesthetic appearance; levels of psychological, physical, and sexual well-being; and overall satisfaction.

Methods: Of 5063 women who underwent immediate reconstruction (n = 3349) or delayed reconstruction (n = 1714) between January 1, 2008, and March 31, 2009, in England, 2923 women who gave informed consent were sent validated, procedure-specific, 18-month follow-up questionnaires. Outcome scale scores ranged from 0 (poor) to 100 (excellent); multiple linear regression was used to adjust scores for patient and treatment characteristics.

Results: Two thousand two hundred eighty-nine women (78 percent) returned completed questionnaires (immediate reconstruction, n = 1528; delayed reconstruction, n = 761). For immediate reconstruction, mean overall satisfaction scores for the various techniques ranged from 67 to 85 (median, 67 to 93). For delayed reconstruction, mean overall satisfaction scores ranged from 70 to 85 (median, 75 to 100). For both groups, similar gradients were observed for the other outcome scales across techniques. Reconstruction using patients’ own tissues tended to have higher mean adjusted scores compared with those techniques using implants alone (p < 0.0001 for aesthetic appearance, psychological well-being, sexual well-being, and satisfaction with outcomes for immediate and delayed reconstruction groups).

Conclusions: Women who underwent autologous reconstruction tended to report greater satisfaction than those who underwent implant reconstruction. These results can inform patients of the anticipated outcomes of their selected surgery, but further research is required to confirm whether autologous reconstruction is superior in general.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Worthing, London, Prescot, Merseyside, West Sussex, Great Yarmouth, Norfolk, and Sheffield, United Kingdom; and Cork, Ireland

From the Clinical Effectiveness Unit, The Royal College of Surgeons of England, the Health Services Research Unit, Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, St Helens and Knowsley Teaching Hospitals NHS Trust, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, James Paget University Hospitals NHS Foundation Trust, University of East Anglia, Norwich Research Park, and Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital; and the Department of Epidemiology and Public Health, University College Cork.

Received for publication May 18, 2016; accepted October 5, 2016.

Disclosure:There was no funding source for this study. There was no support from any organization for the submitted work; there were no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; there were no other relationships or activities that could appear to have influenced the submitted work. None of the authors has a financial interest in any of the products or devices mentioned in this article.

David A. Cromwell, Ph.D., Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PE, United Kingdom, dcromwell@rcseng.ac.uk

Copyright © 2017 by the American Society of Plastic Surgeons