Mastectomy Patients Favor Silicone for Reconstructive Surgery

Nancy Fowler Larson

November 08, 2010

November 8, 2010 — Women undergoing reconstruction after double mastectomy for breast cancer are more satisfied with silicone gel implants than those filled with saline, according to a study published online November 8 in the journal Cancer.

Most women who undergo the surgical removal of a breast do opt for reconstruction and must choose between saline and silicone implants, both of which are FDA-approved. Although surgeons have concluded that silicone results in softer breasts with a more natural feel and less apparent wrinkling, no study has documented patients' preferences.

"Although such surgeon-reported outcomes are noteworthy, the over-riding goal of postmastectomy reconstruction is to satisfy the patient with respect to the outcome," write Colleen McCarthy, MD, MS, from Memorial Sloan-Kettering Cancer Center, New York City, and colleagues.

The investigators conducted a multicenter, cross-sectional study involving 482 women who completed BREAST-Q postoperative reconstruction module questionnaires after mastectomy and breast reconstruction at 3 North American centers. The BREAST-Q measures patient satisfaction in terms of factors including breast shape, feel to the touch, appearance, and whether the breasts feel "normal" and like a natural body part.

The mean age of the 306 women who received saline implants was 51.3 years; the mean age for the 176 women with silicone implants was 53.7 years. Their reconstructive surgeries took place between 1 and 8 years before the study.

Type of Implant 1 of Several Factors Contributing to Satisfaction

As the researchers had hypothesized, the women who had silicone implants were happier with their outcomes, illustrated by a higher mean "satisfaction with breasts" score, than those with saline implants (58.0 ± 20.3 vs 52.5 ± 20.4; P = .004). Results after multivariate analysis for age, follow-up length, laterality, and medical center further demonstrated the trend of favoring silicone (P = .032).

The findings further demonstrated that patient satisfaction was also a product of other factors: undergoing reconstruction on both breasts instead of one, not having undergone radiation, and having had more recent reconstruction, regardless of whether the women had silicone or saline implants, as follows:

  • undergoing bilateral, rather than unilateral, surgery (P ≤ .001);

  • having had no radiotherapy before mastectomy (P = .001) or after surgery (P = .002); and

  • having undergone reconstruction more recently (P = .002).

The findings provide important information for patients facing reconstructive choices and the physicians who advise them.

"We now know that women who elect to proceed with the placement of a silicone implant report higher satisfaction with their reconstructed breasts than those who choose saline implants," Dr. McCarthy said in a news release. "It also appears that patient satisfaction with postmastectomy implant-based reconstruction is generally high and that individual treatment variables — such as implant type — explain only a relatively small amount of the variance. Patient counseling should reflect these realities in order to reassure patients that high satisfaction may be obtained with both saline and silicone implants."

The investigators noted that their study was limited by the lack of pertinent information, including dependable data on the precise kinds of silicone implants the women received, the occurrence of postsurgical complications, and the incidence of further procedures such as contralateral matching and revisions.

"Future studies evaluating the impact of these variables on patients' perceptions of outcome are thus warranted," the authors write.

The study authors have disclosed no relevant financial relationships.

Cancer. Published online November 8, 2010.

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