Patient-reported outcomes following bilateral prophylactic mastectomy and immediate breast reconstruction: comparing implant-based with autologous breast reconstruction

Abstract

Background Since the number of breast cancer genetic gene testing is increasing, more women opt for bilateral prophylactic mastectomy (BPM) followed by breast reconstruction. However, little is known about the differences in Quality of Life (QoL) after various reconstructive surgeries in this population. In this study, the long-term breast-related, body-related, and health-related QoL between immediate implant-based breast reconstruction (IBBR) and autologous breast reconstruction (ABR) were compared, in women who underwent BPM. Methods In this cross-sectional study, women who underwent postmastectomy breast reconstruction between January 2015 and December 2018 were invited for an online questionnaire, in which the BREAST-Q, the BODY-Q and the SF-36 were included. Women who underwent BPM and immediate breast reconstruction were included for analysis. Multivariable linear regression analysis was performed to adjust mean differences in patient-reported outcomes between IBBR and ABR for potential confounders. Results Of the included women (n = 47), 33 underwent ABR and 14 women underwent IBBR following BPM. BREAST-Q scores were in favor of the ABR group before and after adjustment, with statistically significance on Satisfaction with breasts (mean difference 15.8, p = 0.019) and Physical well-being (mean difference 13.5, p = 0.033). None of the mean differences in BODY-Q and SF-36 scores between groups, before and after adjustment, were statistically significant. Conclusion This study suggests that there is a higher satisfaction with breasts and better physical well-being in women who underwent immediate ABR compared to those who underwent immediate IBBR after BPM. However, these data should be interpreted carefully as a result of selection bias and a small sample size. Level of Evidence: Level III, risk study.

Patient‐reported outcomes post prophylactic risk‐reducing mastectomy: improved breast and psychosocial satisfaction yet poorer physical well‐being

“…12 They found higher QoL satisfaction with autologous flap reconstructions in all five major Breast Q© domains, with the greatest mean difference in psychological well-being; 74.1 compared with 63.6. 12 Misere et al contend that improved PROs in all domains may be attributed to the comparatively more natural appearance, feel and aging of autologous reconstructions. 1,12 Our overall findings of relatively high psychosocial well-being and low sexual well-being are consistent with the results of a 2016 systematic review of PROs in patients post-bilateral mastectomy, however, these studies used a wide variety of survey instruments that did not include the BREAST-Q© (Table 1).…”

“…This study is unique in that it is one of the few to examine the QoL outcomes following prophylactic mastectomy from a prospective database. However, this study is cross‐sectional which is similar to many studies investigating QoL in breast surgery patients 12,13 . The aim was to identify longer‐term psychosocial and physical issues in the risk management cohort undergoing prophylactic mastectomy, in order to improve service implementation and indeed, consider routine embedded PROs capture in this cohort.…”

“…Similarly, Misere et al . recently utilized the BREAST‐Q© to assess and compare 33 patients post autologous breast reconstruction and 14 patients post implant‐based reconstruction 12 . They found higher QoL satisfaction with autologous flap reconstructions in all five major Breast Q© domains, with the greatest mean difference in psychological well‐being; 74.1 compared with 63.6 12 .…”

“…Misere et al . contend that improved PROs in all domains may be attributed to the comparatively more natural appearance, feel and aging of autologous reconstructions 1,12 …”

“…12 Misere et al contend that improved PROs in all domains may be attributed to the comparatively more natural appearance, feel and aging of autologous reconstructions. 1,12 Our overall findings of relatively high psychosocial well-being and low sexual well-being are consistent with the results of a 2016 systematic review of PROs in patients post-bilateral mastectomy, however, these studies used a wide variety of survey instruments that did not include the BREAST-Q© (Table 1). 13 This review found that 13 studies reported 61-100% of patients were satisfied with their outcomes.…”