Tracking the aesthetic outcomes of prosthetic breast reconstructions that have complications

Abstract

B reast reconstruction can help moderate the distressing postoperative changes in body image and the quality of life of breast cancer patients undergoing mastectomy (1-4). In particular, the literature has shown aesthetic results following reconstruction to be a major contributor to patient satisfaction and overall quality of life (5). With numerous reconstruction techniques currently available, myriad studies have detailed the postoperative surgical and cosmetic outcomes of such methods. In addition, factors that may influence final aesthetic results, such as body mass index (BMI), preoperative and postoperative radiation, and age, have also been assessed (6-21). However, little data regarding the impact of postoperative complications on aesthetic outcomes of breast reconstruction exist (22). Does having a complication necessarily mean an adverse aesthetic outcome? We endeavored to track aesthetic outcomes following implant reconstruction in patients who experienced a complication. Studies have shown that complications following surgery can negatively impact a patient's health status, extend hospital stays and lead to higher medical bills (23-26). The potential ramifications of complications on local vasculature and wound healing may be of particular importance in the reconstruction population, in which improved aesthetic outcomes enhance a patient's self image and well-being. To date, there has been little investigation into whether complications actually

Microsurgical restoration of failed or unsatisfactory breast reconstruction: a systematic review and pooled-analysis of outcomes

“…In this review, 2 studies compared aesthetic outcomes of patients with autologous conversion to patients that completed prosthetic reconstruction [19,25] . Mioton et al [19] reported superior scores across 4 out of 5 domains evaluated (volume, contour, placement, and inframammary fold) in 18 patients with autologous conversion after complicated implant reconstruction as compared to 136 patients with uncomplicated prosthetic reconstruction.…”

“…They reported a mean overall aesthetic score of 3.25, which was similar to the mean score of 3.28 in patients with non-irradiated implant reconstruction. A validated 3-point scale (0-2) of 5 distinct aesthetic domains was used by another study, which reported mean scores of 1.6 for volume, 1.6 for contour, 1.75 for placement, 1.80 for inframammary fold, and 1.35 for scarring in 18 patients who had autologous conversion after experiencing complication with initial expanderimplant reconstruction [19] . They reported superior scores across 4 of these domains (volume, contour, placement, and inframammarry fold) as compared to patients completed expander implant reconstruction without complication.…”

“…Review of these studies demonstrated significant heterogeneity in methods of evaluation, rating scales, and reporting of aesthetic outcomes. Aesthetic means based on numerical rating scales were reported in 3 studies [11,19,25] . Utilizing a 5-point Likert scale (5, very satisfied; 1, very dissatisfied), one study reported numerical means of self-reported assessments in 29 patients with scores of 4.24 for breast volume, 4.16 for breast shape, 3.83 for symmetry, 3.92 for breast scars, and 3.42 for nipple/ NAC complex [11] .…”

“…Measures of aesthetic outcome or patient satisfaction were reported by 5 studies including 147 patients [11,19,20,25,27] . Review of these studies demonstrated significant heterogeneity in methods of evaluation, rating scales, and reporting of aesthetic outcomes.…”

Axillary Advancement Suture to Minimize Post-Implantation Deformity in Implant: Based Breast Reconstruction

“…Given our ability to achieve these results consistently, predictably, and for the most part reproducibly, many women will focus on what many surgeons would consider minor irregularities. The reality is that contour abnormalities of the breast following prosthetic reconstruction are more common than surgeons realize and constitute the majority of complaints that women have [1]. A common contour abnormality is the scalloping that occurs along the upper lateral aspect of the breast at the junction of the device and the soft tissues.…”