Determinants of Patient Satisfaction in Postmastectomy Breast Reconstruction

Abstract

In today's increasingly competitive health care marketplace, consumer satisfaction has become an important measure of quality. Furthermore, measures of satisfaction with treatment inteerventions are influential factors in determining patients' and payers' choices of health care. This study sought to evaluate satisfaction with postmastectomy breast reconstruction and to assess the effects of procedure type and timing on patient satisfaction. As part of the Michigan Breast Reconstruction Outcome Study, patients undergoing first-time mastectomy reconstruction were prospectively evaluated, including cohorts of women choosing expander/implant, pedicle TRFAM flap, and free TRAM flap procedures. Preoperatively and 1 year postoperatively, participants completed a questionnaire that collected a variety of health status information. The postoperative questionnaire had an additional seven items assessing both general satisfaction with reconstruction (five items) and aesthetic satisfaction (two items) as separate subscales. Patients were asked to respond to each item using a five-point Likert scale. Item responses ranged from 1, indicating high satisfaction, to 5, reflecting low satisfaction. In the data analysis, only patients responding with a 1 or 2 for all of the items within a subscale were classified as "satisfied" for the subscale. To assess the effects of procedure type (implant, pedicle TRAM flap, and free TRAM flap) and timing (immediate versus delayed) on satisfaction and to control for possible confounding effects from other independent variables, multiple logistic regression was employed. In our analysis, odds ratios and associated 95 percent confidence intervals were calculated for each independent variable in the regression. Statistical significance was designated at the p < or = 0.05 level. A total of 212 patients were followed during the period of 1994 to 1997, including 141 immediate and 71 delayed reconstructions. The study population consisted of 49 expander/implant, 102 pedicle TRAM flap, and 61 free TRAM flap reconstruction patients. The analysis showed a significant association between procedure type and patient satisfaction. TRAM flap patients (both free and pedicle) appeared to have significantly greater general and aesthetic satisfaction compared with expander/implant patients (p = 0.03 and 0.001, respectively). Furthermore, pedicle TRAM flap patients were more aesthetically satisfied than those with free TRAM flaps (p = 0.072). The other independent variables of age and procedure timing did not appear to significantly affect either general or aesthetic satisfaction. However, preoperative physical activity was positively correlated with general satisfaction at the p = 0.034 level. The choice of procedure seems to have a significant effect on both aesthetic and general patient satisfaction with breast reconstruction. In this study, autogenous tissue reconstructions produced higher levels of patient aesthetic and general satisfaction compared with implant techniques. Pedicle and free TRAM flap patient...

Impact of the Poly Implant Prosthesis Breast Implants Recall in Women With Breast Reconstruction: A South-Eastern French Cross-Sectional Survey Nested in a Prospective Cohort

“…28,31,32 The results obtained here confirm that satisfaction with Breast Reconstruction does not depend directly on women's age or educational level. 29 Nearly half of young Breast Cancer survivors expressed some regret five years after their treatment; 33 regret about Breast Reconstruction was also observed here in about half of the sample, in line with other studies. 31,32 Post-decisional regrets were observed more frequently in our study when the decision-making was not felt to be sufficiently proactive and in those who were less satisfied with their Breast Reconstruction.…”

“…Satisfaction with the plastic surgeon has been previously reported to predict greater satisfaction with Breast Reconstruction. 28 In previous studies on satisfaction with Breast Reconstruction, the role of various clinical variables was investigated, and women with autologous reconstruction were found to be more satisfied than those with implants, 29 which was confirmed by the present results. Two other variables analyzed in our study were found to be independently related to satisfaction: higher informationseeking profiles and lower health-related literacy.…”

Patient satisfaction with postmastectomy breast reconstruction

“…Different authors have considered the impact of implant versus autogenous tissue techniques and of immediate versus delayed reconstruction. [19][20][21][22] However, to our knowledge, few have attempted to evaluate the effect of more subtle treatment considerations, such as implant type, on patients' perceptions of outcome.…”

“…Our finding, which suggests that both preoperative and postoperative radiotherapy are important predictors of patient satisfaction, is consistent with other published reports. Numerous studies have shown that patients who undergo postmastectomy, implant-based reconstruction after the receipt of preoperative chest wall irradiation have a higher incidence of complications, including capsular contracture, 19,[24][25][26] and that the receipt of postmastectomy adjuvant radiotherapy is correlated with both the development of complications and increased patient dissatisfaction. [27][28][29][30] Thus, the determination of effect size herein allowed clinically meaningful comparisons to be made between the effects of a known entity (such as postmastectomy radiotherapy) versus other clinical variables (such as implant type) that may have an impact on patients' satisfaction with their reconstructed breasts.…”

Management of complications in reconstructive mammoplasties with prostheses: systematic review

“…The cosmetic advantages of reconstruction with prosthesis provide the patient a positive impact on psychosocial aspects, organ functionality, and quality of life 8,9 . They explain the increasing number of indications, even after the increased costs attributed to post-mastectomy reconstruction 10,11 .…”