COMMENTARY

Breast Reconstruction Methods Not Considered Equal

Lidia Schapira, MD

Disclosures

April 17, 2017

Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study

Pusic AL, Matros E, Fine N, et al
J Clin Oncol. 2017 March 27. [Epub ahead of print]

Study Summary

The investigators report on a 5-year prospective, multicenter study involving 57 plastic surgeons in academic and community settings. The study sought to compare reported women's quality of life after two methods of breast reconstruction: implant reconstruction or autologous abdominal tissue reconstruction.

Pusic and colleagues evaluated patient-reported outcomes (PROs) in women undergoing immediate implant-based or autologous breast reconstruction after mastectomy for invasive cancer or ductal carcinoma in situ. A total of 1632 patients enrolled at 11 sites (nine academic and two community) completed a breast-specific PRO at baseline and 1 year after surgery.

At 1 year, patients who had autologous reconstruction reported greater satisfaction with their breasts compared with those who received implants, as well as greater sexual and psychological well-being; they also rated these items higher than on their baseline report. Physical well-being in the chest was not fully restored at 1 year for either group, nor was well-being in the abdomen for those who had autologous reconstruction. After 1 year, anxiety and depression had lessened in both groups, and patients who had implants noted less fatigue and pain than their counterparts.

Viewpoint

Rates of bilateral mastectomies have increased in recent years because of patient preferences. However, our knowledge about the satisfaction with surgical outcomes and reconstructive procedures remains limited. Breast reconstruction can help restore body image and alleviate distress associated with mastectomy. This is the first study to use a validated PRO instrument designed specifically for patients who undergo breast surgery (BREAST-Q). It included baseline assessments conducted at multiple institutions.

The take-home message is that at 1 year post-mastectomy, patients who chose to have autologous abdominal tissue-based reconstruction (and no differences observed between procedures) were more satisfied with their body image and reported greater psychosocial and sexual well-being than those who received implants, but their level of physical well-being was worse than at baseline (due to pain and fatigue).

These differences in determinants of physical and emotional well-being at 1 year post-mastectomy are important in counseling patients who are considering these procedures.

These findings will require longer follow-up. Of note, the investigators also found a decrease in anxiety and fear, and this is important for those engaged in counseling patients at their initial diagnosis.

Abstract

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