!Aim: Breast reconstruction has become increasingly important for the body image of women with breast cancer. We conducted a study to investigate how patient characteristics correlate with surgical outcome after breast reconstruction with implant after mastectomy and to identify risk factors which could facilitate patient selection for reconstruction. Patients and Methods: For this case cohort analysis (n = 257 patients with 318 heterologous reconstructions), we analyzed BMI, smoking, preexisting disease, chemotherapy and radiotherapy, one-stage/two-stage reconstruction, immediate/ delayed reconstruction, antibiotic therapy and complications, partner interaction and adherence to the decision for reconstruction using a customized questionnaire. Results: 257 patients with 318 implant reconstructions (196 unilateral, 61 bilateral) were eligible for inclusion in the study. Median follow-up time was 3.1 years (range: 1 month to 10 years). Response rate to the questionnaire was 71.8 %. Median age was 49 years (range 24-79 years), median BMI was 22.44 (range 16.33-40.09). A BMI > 30 was inversely correlated with positive self-image (p = 0.004), and implant loss/rotation was more frequent in this group (p < 0.05). Smoking > 10 cigarettes/day had a negative impact on surgical outcome. A positive self-image had a positive impact on partner interaction (p < 0.001) and was correlated with a lower perception of pain. Aesthetic results did not vary with age (p = 0.054). Titanized polypropylene meshes were used to protect against implant rotation (p = 0.034). Rates of capsular fibrosis were low in our cohort (< 10%), and implant loss rate was less than 2 %. Conclusions: This study offers a differentiated approach for the pre-surgical counselling of patients and shows that patients up to 80 years of age are
Background. Breast reconstruction after mastectomy is gaining increasing significance avoiding the post-mastectomy-trauma and providing the patients with a normal body image after breast cancer survival. This study was conducted to investigate the patients’ characteristics and comorbidities in correlation with the surgical outcome of expander-implant-reconstruction after mastectomy. Patients’ satisfaction with the surgical result and self-perception as well as their partner interaction were also analyzed in their dependance of these patient-related data. Methods. In this large retrospective cohort study 258 women were enrolled with expander- and/or implant-reconstruction in a single-institution-setting of a 10-years-period (2000-2009). Patient's satisfaction with the result of surgery was evaluated by questionnaires and interviews and patient-related data were retrieved like BMI, smoking, pre-existing diseases and chemo- and radiotherapy, the differentiation between one-stage/two-stage reconstruction, immediate/delayed reconstruction, antibiotics and complications (secondary bleeding, pain, capsular contracture, implant rotation, etc.). Finally, the patients’ interaction with their partners and their adhaerence to their decision for reconstruction was investigated. For explorative statistical analyses we used standard univariate methods appropriately for the scale level of the variables (e.g. Fishers exact tests for n x m Tables or exact Wilcoxon Mann Whitney tests to compare two distributions) and applied a significance level a of 5% to each test. Results: BMI and patients’ satisfaction with the aesthetic result was inversely correlated (p=0,004) and a negative self-perception had a negative impact on interaction with the partner (p<0,001) after breast reconstruction. BMI was positively correlated with the loss of the implant (p=0,005). Further comorbidities led to worse patients’ satisfaction in rating of the aesthetic results. Conclusion: Patients characteristics like obesity and other comorbidites are associated with lower patients’ satisfaction with the surgical outcome after expander-implant-breast reconstruction. A decrease of satisfaction is detectable after expander-implant reconstruction within years compared to autologous reconstruction. These results should be taken into consideration for counselling of patients opting for breast reconstruction after mastectomy. This is to our knowledge the largest single-institution study evaluating the patients’ satisfaction with implant-reconstruction after breast cancer treatment and comparing the outcome with various patient characteristics giving a rationale for selection of the optimal reconstructive method. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-08.
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