A comprehensive literature review of patient‐reported outcome measures (PROMs) among common breast reconstruction options: What types of breast reconstruction score well?

Abstract

Purpose Breast cancer continues to be the most prevalent cancer affecting women. Many reconstructive options exist after oncologic resection. Breast reconstruction can have a lasting impact on many areas of the patient's life, and therefore, a high consideration for patient satisfaction is crucial. Patient‐reported outcome measures (PROMs) provide an important tool in the evaluation of different surgical methodologies. The aim of this comprehensive systematic review is to look at various surgical modalities in breast reconstruction as they relate to patient satisfaction. Methods A PubMed PRISMA search was performed. Criteria for inclusion included nipple‐sparing or skin‐sparing mastectomy with autologous or implant‐based reconstruction, level 2 volume displacement or volume replacement oncoplastic surgery, and measurement of patient‐reported outcomes using the BREAST‐Q or other validated PROMs. From the data set, weighted proportions were generated and analyzed using the Kruskal‐Wallis rank sum test and a post hoc Dunn's test. Results After obtaining 254 full text copies, 43 articles met inclusion criteria and were included. Analysis of BREAST‐Q data showed oncoplastic breast surgery was significantly preferred over mastectomy regardless of the type of reconstruction. Nipple‐sparing was significantly preferred over skin‐sparing mastectomy, autologous reconstruction was significantly preferred over implant‐based reconstruction, and prepectoral implant placement was preferred over subpectoral implant placement. Validated PROMs other than BREAST‐Q showed similar trends in all but type of mastectomy. Conclusions In this comprehensive systematic review, oncoplastic surgery showed the most favorable PROMs when compared to other reconstructive modalities. Autologous was preferred over implant‐based reconstruction, and prepectoral was preferred over subpectoral implant placement.

The Use of Hemostatic Agents to Decrease Bleeding Complications in Breast Cancer Surgery

“…17,18 Oncoplastic surgery showed the most favorable PROMs when compared to other reconstructive modalities. 19 Its oncologic utility lies in the ability to perform a large partial mastectomy, resulting in a decreased positive margin rate, while utilizing local tissue rearrangement to reconstruct the breast. OPS can be further categorized into level 1 volume displacement, level 2 volume displacement, and volume replacement based on the American Society of Breast Surgeons definitions.…”

Innovative Standards in Oncoplastic Breast Conserving Surgery: From Radical Mastectomy to Extreme Oncoplasty

“…Other available options are the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, and the EORTC QLQ-BR23 questionnaires [89-91]. In a literature review by Char et al [92], BREAST-Q data showed OBCS had significantly higher scores than mastectomy regardless of the type of the reconstruction performed. In another systematic review performed by Aristokleous and Saddiq [93] evaluating patients’ QOL, OBCS was found to be associated with a trend toward better patient QOL than BCS alone.…”

Editorial on Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis

“…Recent studies have demonstrated that oncoplastic surgery in general has higher patient-reported outcomes compared with mastectomy operations. 8 Nevertheless, like doctors, patients are unique individuals and surgical plans need to be formulated with empathy, support, and evidence-based discussion, with focus on patient-specific preferences (size preference of breast, etc.). Furthermore, the relative fiscal impact of each choice with specific regards to financial toxicity to the patient has yet to be studied in detail, but is definitely a significant real-world issue that impacts decision-making.…”