Skip to main content
SpringerLink
Log in

A retrospective investigation of women’s experience with breast reconstruction after mastectomy

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

A diagnosis of breast cancer is often accompanied by the fear of loss of previous body image and attractiveness. Hence, many patients opt for reconstructive surgery. This study evaluated the effects of different types of reconstructive surgery after mastectomy on the functional and psychological adjustment of patients.

Methods

In a cohort study, patients, who had breast reconstruction after mastectomy by means of four different allogenic or autologues techniques between 1999–2006 were retrospectively interviewed in person or by telephone. The questions addressed complication rates, physical complaints, functional impairments, body image outcomes, sexuality and patient satisfaction.

Results

Of 139 patients, 89 (64.7 %) completed the survey. 32 (35.9 %) patients experienced one or more postoperative complications like seroma, hematoma, infections or necrosis. 16 (20 %) and 13 (16 %) patients reported strong and moderate adverse effects on sexuality, respectively. 62 (70 %) patients indicated that they were actively included in the decision making process. Patient ratings of good or bad medical advice were associated with complication rates (p = 0.008). Patients, who evaluated their first preoperative counseling positively, reported higher consent rates when a re-reconstruction became necessary (p ≤ 0.001). Satisfaction with the functional outcome after reconstruction and satisfaction with the cosmetic result was highly correlated (p < 0.001).

Conclusions

A significant association of patient satisfaction with postoperative complications and the decision for a re-reconstruction was demonstrated. Furthermore, our results emphasize the importance of detailed preoperative counseling for women’s adjustment to reconstructive surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Schrodi S, Engel J, Heywang-Köbrunner SH, Schubert-Fritschle G (2011) Epidemiologie. Tumorzentrum München, Manual Mammakarzinome 13:1–11

  2. Untch M (2008) Diagnostik und Therapie der Mammakarzinoms. State of the art 249–260

  3. Riedner C, Haidinger R, Hermelink K, Köhm J (2011) Psychoonkologische Gesichtspunkte. Tumorzentrum München, Manual Mammakarzinome 13. Auflage 225–242

  4. Fobair P et al (2006) Body image and sexual problems in young women with breast cancer. Psychooncology 15(7):579–594

    Article  PubMed  Google Scholar 

  5. Schover LR (1994) Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr 16:177–82

    Google Scholar 

  6. Dian D, Anthuber A, Bauerfeind I, Beyreuther HJ, Braun M et al (2011) Operative Therapie des primären Mammakarzinoms und Rekonstruktionsverfahren. Tumorzentrum München, Manual Mammakarzinome 13. Auflage 121–123

  7. Hopwood P et al (2001) A body image scale for use with cancer patients. Eur J Cancer 37(2):189–197

    Article  PubMed  CAS  Google Scholar 

  8. Hu E, Alderman AK (2007) Breast reconstruction. Surg Clin North Am 87(2):453–467

    Article  PubMed  Google Scholar 

  9. AGO-Leitlinien. http://www.ago-online.org/

  10. Handel N, Silverstein MJ (2006) Breast cancer diagnosis and prognosis in augmented women. Plast Reconstr Surg 118(3):587–593 (discussion 594–6)

    Article  PubMed  CAS  Google Scholar 

  11. Munhoz AM et al (2005) Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. Plast Reconstr Surg 116(3):741–752

    Article  PubMed  CAS  Google Scholar 

  12. Chang DW et al (2000) Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 105(5):1640–1648

    Article  PubMed  CAS  Google Scholar 

  13. Garbay JR, Rietjens M, Petit JY (1992) Esthetic results of breast reconstruction after amputation for cancer. 323 cases. J Gynecol Obstet Biol Reprod (Paris) 21(4):405–412

    CAS  Google Scholar 

  14. Alderman AK et al (2002) Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 109(7):2265–2274

    Article  PubMed  Google Scholar 

  15. Bresser PJ et al (2006) Satisfaction with prophylactic mastectomy and breast reconstruction in genetically predisposed women. Plast Reconstr Surg 117(6):1675–1682 (discussion 1683–4)

    Article  PubMed  CAS  Google Scholar 

  16. Saulis AS, Mustoe TA, Fine NA (2007) A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures. Plast Reconstr Surg 119(6):1669–1676 (discussion 1677–8)

    Article  PubMed  CAS  Google Scholar 

  17. Krueger EA et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49(3):713–721

    Article  PubMed  CAS  Google Scholar 

  18. Rosenqvist S, Sandelin K, Wickman M (1996) Patients’ psychological and cosmetic experience after immediate breast reconstruction. Eur J Surg Oncol 22(3):262–266

    Article  PubMed  CAS  Google Scholar 

  19. Dian D et al (2007) Aesthetic result among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy. Arch Gynecol Obstet 275(6):445–450

    Article  PubMed  Google Scholar 

  20. Gerber B et al (2009) The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 249(3):461–468

    Article  PubMed  Google Scholar 

  21. Tarantino I, Banic A, Fischer T (2006) Evaluation of late results in breast reconstruction by latissimus dorsi flap and prosthesis implantation. Plast Reconstr Surg 117(5):1387–1394

    Article  PubMed  CAS  Google Scholar 

  22. Andrade WN, Semple JL (2006) Patient self-assessment of the cosmetic results of breast reconstruction. Plast Reconstr Surg 117(1):44–47 (discussion 48–9)

    Article  PubMed  CAS  Google Scholar 

  23. Fee-Fulkerson K et al (1996) Factors contributing to patient satisfaction with breast reconstruction using silicone gel implants. Plast Reconstr Surg 97(7):1420–1426

    Article  PubMed  CAS  Google Scholar 

  24. Cederna PS et al (1995) Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous flap versus breast implant reconstruction. Ann Plast Surg 35(5):458–468

    Article  PubMed  CAS  Google Scholar 

  25. Franchelli S et al (1995) Psychological evaluation of patients undergoing breast reconstruction using two different methods: autologous tissues versus prostheses. Plast Reconstr Surg 95(7):1213–1218 (discussion 1219–20)

    Article  PubMed  CAS  Google Scholar 

  26. Metcalfe KA, Semple J, Quan ML, Vadaparampil ST, Holloway C, Brown M, Bower B, Sun P, Narod SA (2012) Changes in psychosocial functioning 1 year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction. Ann Surg Oncol 19(1):233–241

    Article  PubMed  Google Scholar 

  27. Brandberg Y, Malm M, Blomqvist L (2000) A prospective and randomized study, “SVEA,” comparing effects of three methods for delayed breast reconstruction on quality of life, patient-defined problem areas of life, and cosmetic result. Plast Reconstr Surg 105(1):66–74 (discussion 75–6)

    Article  PubMed  CAS  Google Scholar 

  28. Guyomard V, Leinster S, Wilkinson M (2007) Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy. Breast 16(6):547–567

    Article  PubMed  Google Scholar 

  29. Guyomard V, Leinster S, Wilkinson M, Servant JM, Pereira J (2009) A Franco-British patients’ and partners’ satisfaction audit of breast reconstruction. J Plast Reconstr Aesthet Surg 62:782–789

    Article  PubMed  CAS  Google Scholar 

  30. Alderman AK et al (2000) Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 106(4):769–776

    PubMed  CAS  Google Scholar 

  31. Shaikh-Naidu N et al (2004) Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction. Ann Plast Surg 52(5):465–470 (discussion 470)

    Article  PubMed  Google Scholar 

  32. Edsander-Nord A, Brandberg Y, Wickman M (2001) Quality of life, patients’ satisfaction, and aesthetic outcome after pedicled or free TRAM flap breast surgery. Plast Reconstr Surg 107(5):1142–1153 (discussion 1154–5)

    Article  PubMed  CAS  Google Scholar 

  33. Ramon Y et al (1997) Aesthetic results and patient satisfaction with immediate breast reconstruction using tissue expansion: a follow-up study. Plast Reconstr Surg 99(3):686–691

    Article  PubMed  CAS  Google Scholar 

  34. Gerber B et al (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238(1):120–127

    PubMed  Google Scholar 

  35. Rowland JH et al (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92(17):1422–1429

    Article  PubMed  CAS  Google Scholar 

  36. Krychman ML, Katz A (2012) Breast cancer and sexuality: multi-modal treatment options. J Sex Med 9(1):5–13 (quiz 14–5). doi:10.1111/j.1743-6109.2011.02566.x

    Google Scholar 

  37. Contant CM et al (2000) Motivations, satisfaction, and information of immediate breast reconstruction following mastectomy. Patient Educ Couns 40(3):201–208

    Article  PubMed  CAS  Google Scholar 

  38. Keating NL et al (2003) Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed? Breast Cancer Res Treat 79(2):225–231

    Article  PubMed  Google Scholar 

  39. Sheehan J et al (2007) Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction. Psychooncology 16(4):342–351

    Article  PubMed  Google Scholar 

  40. Vodermaier A, Caspari C, Wang L, Köhm J, Ditsch N, Untch M (2011) How and for whom are decision aids effective? Long-term psychological outcome of a randomized controlled trial in women with newly diagnosed breast cancer. Health Psychol 30(1):12–19

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank all patients who participated in the survey and follow-up.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Breast Center, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany

    Nina Ditsch, Andrea Vodermaier, Isabelle Himsl, Nadia Harbeck & Miriam Lenhard

  2. Department of Obstetrics and Gynecology, Klinikum Landshut, Robert-Koch-Str.1, 84034, Landshut, Germany

    Ingo Bauerfeind & Bettina Löhrs

  3. Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T1Z4, Canada

    Andrea Vodermaier

  4. Department of Surgery, Kliniken Ostallgäu-Kaufbeuren, Dr. Gutermann-Str. 2, 87600, Kaufbeuren, Germany

    Christina Tripp

  5. Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University, Vossstr. 9, 69115, Heidelberg, Germany

    Bettina Toth

  6. Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany

    Monika Graeser

  7. Comprehensive Cancer Center (CCC-LMU), University of Munich, Munich, Germany

    Nadia Harbeck

Authors
  1. Nina Ditsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ingo Bauerfeind
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Vodermaier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christina Tripp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bettina Löhrs
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bettina Toth
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Isabelle Himsl
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Monika Graeser
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nadia Harbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Miriam Lenhard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nina Ditsch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ditsch, N., Bauerfeind, I., Vodermaier, A. et al. A retrospective investigation of women’s experience with breast reconstruction after mastectomy. Arch Gynecol Obstet 287, 555–561 (2013). https://doi.org/10.1007/s00404-012-2590-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-012-2590-1

Keywords

Search

Navigation