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Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q

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Abstract

Staged expander–implant breast reconstruction (EIBR) and microsurgical abdominal flap breast reconstruction (MAFBR) are the most common modes of breast reconstruction (BR) in the United States. Whether the mode of breast reconstruction has an impact on patient quality of life (QoL) and satisfaction remains a question. A retrospective study was conducted identifying a population of 119 patients who underwent unilateral immediate BR. Only patients who were eligible for either EIBR or MAFBR based on preoperative characteristics were included in the study. The following parameters were retrieved: demographics, mode of reconstruction, cancer, recovery, QoL, and patient satisfaction. The latter two parameters were determined using the BREAST-Q BR module questionnaire. Two-way analysis of variance with mode of reconstruction and occurrence of complication as independent variables was used to determine the effect on patient satisfaction and QoL. The association between mode of reconstruction and patient response with each item of the QoL and satisfaction survey domains was analyzed. The overall response rate was 62.2 %. Non-respondents and respondents did not significantly differ in demographics, surgery type, cancer staging, adjuvant therapy, and complication rate. Age and BMI were significantly higher in MAFBR, while level of education was higher in EIBR. MAFBR had higher scores in psychosocial and sexual wellbeing, satisfaction with outcome, breast, information, and plastic surgeon when compared with patients who underwent EIBR. For patients eligible for both MAFBR and EIBR, MAFBR is associated with higher levels of satisfaction and QoL. Comprehensive pre-operative information of pros and cons of both modes of BR is crucial for patients to make a well-informed decision, thus, resulting in higher levels of satisfaction.

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Abbreviations

EIBR:

Staged expander/implant breast reconstruction

MAFBR:

Microsurgical abdominal flap breast reconstruction

DIEP:

Deep inferior epigastric perforator

MS-TRAM:

Muscle sparing transverse rectus abdominis myocutaneous flap

SIEA:

Superficial inferior epigastric artery

BMI:

Body mass index

ER:

Estrogen receptor

PR:

Progesterone receptor

NAC:

Nipple areola complex

DM:

Diabetes mellitus

PROs:

Patient-reported outcomes

QoL:

Quality of life

BR:

Breast reconstruction

FACT-B:

Functional assessment of cancer therapy-breast

EORTC QLQ-BR23:

European organization for research and treatment of cancer breast cancer-specific quality of life questionnaire

BIS:

Body image scale

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Acknowledgments

This study was supported by the Chinese Government Scholarship 2011811553 and Scholarship for Outstanding Young Plastic Surgeons by Plastic Surgery Hospital, Peking Union Medical College, to Dr. Chunjun Liu. We wish to acknowledge Alex McMillan, PhD, and Gomathi Krishnan, PhD for their support in cohort building and statistical analysis. We also thank Mrs. Christine Reyes-Santos for her help in questionnaire coordination. Part of this study has been presented orally in the 7th World Congress of World Society of Reconstructive Microsurgery in Chicago, USA, 2013.

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical standards

Stanford University Institutional Review Board approval was obtained prior to conducting the present study (IRB-24752).

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Authors and Affiliations

  1. Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China

    Chunjun Liu, Yan Zhuang & Jie Luan

  2. Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA, 94304-5715, USA

    Chunjun Liu, Arash Momeni, Michael T. Chung, Eric Wright & Gordon K. Lee

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  1. Chunjun Liu
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  2. Yan Zhuang
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  3. Arash Momeni
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  4. Jie Luan
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  6. Eric Wright
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  7. Gordon K. Lee
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Correspondence to Gordon K. Lee.

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Chunjun Liu and Yan Zhuang have contributed equally as co-first authors.

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Liu, C., Zhuang, Y., Momeni, A. et al. Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q. Breast Cancer Res Treat 146, 117–126 (2014). https://doi.org/10.1007/s10549-014-2981-z

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