BACKGROUND: Direct to implant (DTI) prepectoral breast reconstruction has recently resurged due to its several advantages including reduced postoperative pain and animation deformity.1 Furthermore, prepectoral reconstruction is associated with decreased hospital stay, faster return to work, and an earlier return to activity compared to subpectoral procedures.2 BREAST-Q, a well-validated patient-reported outcomes (PROs) tool, assesses patient satisfaction and quality of life. Studying PROs has shown to improve patient quality of care by guiding surgical methodology and development.3 Furthermore, with increased patient autonomy and decision-making, patients often use PROs to help guide their decisions regarding future surgeries.4 To that end, the goal of this study was to assess patients’ reported and esthetic outcomes following DTI prepectoral breast reconstruction at 6 months and 1-year follow-up.
METHODS: Sixty-five consented adult patients undergoing DTI prepectoral breast reconstruction postmastectomy completed BREAST-Q questionnaires preoperatively and at 6 and 12 months postoperatively. The primary outcome was BREAST-Q scores mainly satisfaction with breasts, psychosocial well-being, sexual well-being, and physical well-being. In addition, 201 patients were assessed for esthetic outcomes including the need for revision surgeries, implant-related issues, deformities, and capsular contracture. Repeat-measure analyses of variance and dependant t tests were performed on the primary outcomes. Moreover, a bivariate analysis using a Fisher exact test and a regression model correcting for covariates were performed.
RESULTS: Mean satisfaction of breast decreased from 59.2 preoperatively to 58.3 at 12 months (P > 0.05; n = 41). Psychosocial well-being improved from 69.1 preoperatively to 73.5 at 12-month follow-up (P > 0.05; n = 41). Physical well-being of the chest did not significantly change from 76.1 preoperatively to 75.2 at 12 months follow-up (P > 0.05; n = 41). Likewise, sexual well-being did not significantly change from 61.5 preoperatively to 60.9 at 12 months. There was no significant effect of acellular dermal matrix or postmastectomy radiation therapy on any of the PROs studied domains. The esthetic profiles of the patients results are also presented.
CONCLUSION: Patients who underwent DTI prepectoral breast reconstruction were overall satisfied with outcomes. They were as physically satisfied with their implanted breast as they were with their premastectomy natural breasts. Moreover, the results show that patients’ sexual well-being and psychosocial state were not affected by the surgery as evident at 6 months and 1-year follow-ups.
1. Storm-Dickerson T, Sigalove N. Prepectoral breast reconstruction: the breast surgeon’s perspective. Plast Reconstr Surg. 2017;140(6S Prepectoral Breast Reconstruction):43s–48s.
2. Salibian AA, Frey JD, Choi M, et al. Subcutaneous implant-based breast reconstruction with acellular dermal matrix/mesh: a systematic review. Plast Reconstr Surg Glob Open. 2016;4:e1139–e1139.
3. Greenhalgh J, Meadows K. The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: a literature review. J Eval Clin Pract. 1999;5:401–416.
4. Pusic AL, Chen CM, Cano S, et al. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg. 2007;120:823–837; discussion 838–829.