Women's Recovery Experiences After Breast Cancer Reconstruction Surgery

Spector, Denise; Mayer, Deborah K.; Knafl, Kathleen A.; Pusic, Andrea L.

doi:10.1080/07347332.2011.615384

Cited by 36 publications

(47 citation statements)

References 11 publications

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“…While implant loss may be perceived as a less significant complication than the loss of a free flap, any reconstructive loss is a tremendous psychological setback. 34,36 This is highlighted by our finding that only 14.3% of the implant patients vs. 85.7% of the flap patients who lost their reconstruction ultimately chose to undergo a second attempt at breast reconstruction. Unfortunately, the retrospective design of our study prevents our discovering whether this discrepancy reflects differences in patient- or surgeon-driven decision-making, as the patients who elected to undergo the added initial morbidity of free flap breast reconstruction may simply have represented a self-selected group that was more motivated with regard to breast reconstruction in general.…”

Section: Discussionmentioning

confidence: 96%

The Advantages of Free Abdominal-Based Flaps over Implants for Breast Reconstruction in Obese Patients

Garvey

Villa

Rozanski

et al. 2012

Plastic and Reconstructive Surgery

118

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BACKGROUND We hypothesized that for obese patients, abdominal-based free flap, rather than implant-based, and delayed, rather than immediate, breast reconstruction would result in fewer overall complications and reconstruction losses. METHODS We retrospectively analyzed consecutive implant- and abdominal-based free-flap breast reconstructions performed in obese patients between 2005 and 2010 utilizing the World Health Organization obesity classifications: class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2), and class III (≥40 kg/m2). Primary outcome measures included flap failures and overall complications. Logistic regression analysis identified associations between patient, defect, and reconstructive characteristics and surgical outcomes. RESULTS The analysis included 990 breast reconstructions (548 flaps vs. 442 implants) in 700 patients. Mean follow-up was 17 months. Age (p<0.01), smoking (p=0.02), medical illness (p=0.01), and BMI>37 (p=0.01) predicted overall complications on regression analysis. Implants demonstrated a higher failure rate (15.8%) than flaps (1.5%; p<0.001). While failure rates were similar for immediate and delayed flap reconstructions overall (1.3% vs. 1.9%; p=0.7) and among obesity classifications, there was a trend toward more implant failures in immediate rather than delayed reconstructions (16.8% vs. 5.3%; p=0.06). Differences between immediate implant versus flap reconstruction failure rates were highest among more obese patients (class II [24.7% vs. 1.3%, respectively; p<0.01] and class III [25.4% vs. 0%, respectively; p<0.01] compared to class I [11.7% vs. 1.4%, respectively; p<0.01]). CONCLUSIONS Obese patients, particularly patients with class II and III obesity, experience higher failure rates with implant-based breast reconstruction, particularly immediate reconstruction. Free flap techniques or delayed implant reconstruction may be warranted in this population.

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Section: Discussionmentioning

confidence: 96%

The Advantages of Free Abdominal-Based Flaps over Implants for Breast Reconstruction in Obese Patients

Garvey

Villa

Rozanski

et al. 2012

Plastic and Reconstructive Surgery

118

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“…Although many studies investigated the psychosocial impact of BR after mastectomy, only few, mostly retrospective studies, focused on the effects of complications and subsequent surgery on psychological distress [10,13,14,15,16]. One retrospective quantitative study ( n = 60) covering a very short follow-up period of three months after surgery, reported that psychological distress levels were similar for women with and without complications [14].…”

Section: Introductionmentioning

confidence: 99%

“…One retrospective quantitative study ( n = 60) covering a very short follow-up period of three months after surgery, reported that psychological distress levels were similar for women with and without complications [14]. Two qualitative studies in very small samples ( n = 6, and n = 21) found that women were unprepared for the BR course, that they felt it was burdensome physically as well as emotionally, and that the additional operations and the long recovery period were disappointing and unexpected, regardless of complications [10,15]. A recent prospective study covering a follow-up period of more than one year (n = 97) demonstrated a significant impact of complications on psychological wellbeing after autologous BR [16].…”

Section: Introductionmentioning

confidence: 99%

Most women recover from psychological distress after postoperative complications following implant or DIEP flap breast reconstruction: A prospective long-term follow-up study

et al. 2017

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BackgroundSubstantial complication rates after postmastectomy breast reconstruction (BR) in breast cancer patients have been reported. Few studies have reported on the resulting psychological distress (PD) and satisfaction with the aesthetic result in relation to postoperative complications after completion of implant or DIEP flap BR. The present study investigated whether women were able to recover from complication related distress in the long term.MethodsPD was prospectively measured using questionnaires regarding anxiety, depression and cancer distress. Eligible patients completed questionnaires before BR (T0, n = 144), after one month (T1, n = 139) and after completion of BR, approximately 21 months after initial reconstructive surgery (T2, n = 119). Satisfaction with the aesthetic result was assessed 21 months after BR. Data concerning complications, subsequent additional surgery and total reconstruction failure up to T2 were collected from the medical records. Analyses were performed using multi-level regression analyses correcting for age.ResultsOne or more complications occurred in 61 patients (42%) and 50 women required subsequent surgery (35%). In time, mean PD significantly declined towards baseline scores independent of complications. However, a total reconstruction failure (n = 10) was significantly associated with a large temporary increase in depression scores. After additional surgery due to complications patients were less satisfied with aesthetic outcome, although patient satisfaction was independent of PD.ConclusionsPD outcomes generally declined to normal levels after completion of the entire BR course. Patients experiencing a total reconstruction failure reported more depression after this loss, but in the long term recovered to the same level as women without complications. These findings indicate that women generally can cope efficiently with these serious adverse events, even if they were less satisfied with the aesthetic result.

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“…papel significativo na forma como as mulheres lidam com as diversas experiências de ser uma sobrevivente de cancro da mama, pois a reconstrução ajuda a esquecê-lo (Spector et al, 2011).…”

Section: Discussionunclassified

“…Então, emocionalmente, as mulheres adaptam-se facilmente a esta situação, o que significa que a reconstrução tem um papel significativo na forma como as mulheres lidam com as diversas experiências de ser uma sobrevivente de cancro da mama, pois a reconstrução ajuda a esquecer o diagnóstico (Spector, Mayer, Knafl, & Pusic, 2011).…”

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Adaptation to Breast Cancer and Gynecological Cancer in Pre- and Postoperative Period

Alves¹,

Pereira

2013

Psychol. Community Health

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ResumoObjetivo: Investigar a adaptação ao cancro da mama e cancro ginecológico no período pré e pós-operatório revela-se o principal objetivo deste estudo, de forma a que se possa conhecer o impacto emocional bem como os recursos sociais e a forma como as mulheres lidam com a sua situação clínica, para uma intervenção adequada em ambas as fases. Método: A amostra é constituída por 76 mulheres diagnosticadas com cancro da mama, cancro ginecológico e a realizar reconstrução oncoplástica e que estejam a ser seguidas em situação de internamento sendo reincidentes ou não. Os dados foram recolhidos junto destas numa fase pré-operatória e/ou pós-operatória. Resultados: Relativamente às diferenças entre o período pré e pós-operatório ao nível emocional, verificamos que apenas a diminuição da ansiedade do período pré para o pós-operatório é estatisticamente significativa. Conclusão: Os níveis de ansiedade nestas mulheres tende a decrescer do período pré para o pós-operatório. Constatamos ainda que, a adaptação no geral aumenta ligeiramente enquanto a satisfação com o suporte social diminui.Palavras-Chave: cancro da mama, cancro ginecológico, reconstrução oncoplástica, período pré e pós-operatório, adaptação, suporte social Abstract Aim: To investigate the adaptation to breast cancer and gynecological cancer in pre-and postoperative periods is the main objetive of this study, to better understand the emotional impact, the social resources, and how women deal with their clinical situation for developing an appropriate intervention at both phases. Method: The sample is composed of 76 women diagnosed with breast cancer or gynecological cancer who underwent oncoplastic reconstruction, and who were followed during hospitalization, with relapse or without. The data were collected during the preoperative and / or postoperative periods. Results: Regarding the differences between the pre-and postoperative periods on an emotional level, we found that only a decrease in anxiety from the pre-to postoperative period was statistically significant. Conclusion: Anxiety levels in these women tend to decrease from the pre-to the postoperative period. We also noted that, the general adaptation increases slightly while satisfaction with social support decreases.

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Women's Recovery Experiences After Breast Cancer Reconstruction Surgery

Cited by 36 publications

References 11 publications

The Advantages of Free Abdominal-Based Flaps over Implants for Breast Reconstruction in Obese Patients

The Advantages of Free Abdominal-Based Flaps over Implants for Breast Reconstruction in Obese Patients

Most women recover from psychological distress after postoperative complications following implant or DIEP flap breast reconstruction: A prospective long-term follow-up study

Adaptation to Breast Cancer and Gynecological Cancer in Pre- and Postoperative Period

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