Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

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Abstract

<div class="section"> <a class="named-anchor" id="ab-soi180030-1">  </a> <h5 class="section-title" id="d943897e339">Importance</h5> <p id="d943897e341">Previous outcome studies comparing implant and autologous breast reconstruction techniques have been limited by short-term follow-up, single-center design, and a lack of rigorous patient-reported outcome data. An understanding of the expected satisfaction and breast-related quality of life associated with each type of procedure is central to the decision-making process. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi180030-2">  </a> <h5 class="section-title" id="d943897e344">Objective</h5> <p id="d943897e346">To determine outcomes reported by patients undergoing postmastectomy breast reconstruction using implant or autologous techniques 2 years after surgery. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi180030-3">  </a> <h5 class="section-title" id="d943897e349">Design, Setting, and Participants</h5> <p id="d943897e351">Patients were recruited from 11 centers (57 plastic surgeons) across North America for the Mastectomy Reconstruction Outcomes Consortium study, a prospective, multicenter trial, from February 1, 2012, to July 31, 2015. Women undergoing immediate breast reconstruction using implant or autologous tissue reconstruction after mastectomy for cancer treatment or prophylaxis were eligible. Overall, 2013 women (1490 implant and 523 autologous tissue reconstruction) met the inclusion criteria. All patients included in this analysis had 2 years of follow-up. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi180030-4">  </a> <h5 class="section-title" id="d943897e354">Exposures</h5> <p id="d943897e356">Procedure type (ie, implant vs autologous tissue reconstruction).</p> </div><div class="section"> <a class="named-anchor" id="ab-soi180030-5">  </a> <h5 class="section-title" id="d943897e359">Main Outcomes and Measures</h5> <p id="d943897e361">The primary outcomes of interest were scores on the BREAST-Q, a validated, condition-specific, patient-reported outcome instrument, which were collected prior to and at 2 years after surgery. The following 4 domains of the BREAST-Q reconstruction module were evaluated: satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being. Responses from each scale were summed and transformed on a 0 to 100 scale, with higher numbers representing greater satisfaction or quality of life. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi180030-6">  </a> <h5 class="section-title" id="d943897e364">Results</h5> <p id="d943897e366">Of the 2013 women in the study (mean [SD] age, 48.1 [10.5] years for the group that underwent implant-based reconstruction and 51.6 [8.7] years for the group that underwent autologous reconstruction), 1217 (60.5%) completed questionnaires at 2 years after reconstruction. After controlling for baseline patient characteristics, patients who underwent autologous reconstruction had greater satisfaction with their breasts (difference, 7.94; 95% CI, 5.68-10.20; <i>P</i> < .001), psychosocial well-being (difference, 3.27; 95% CI, 1.25-5.29; <i>P</i> = .002), and sexual well-being (difference, 5.53; 95% CI, 2.95-8.11; <i>P</i> < .001) at 2 years compared with patients who underwent implant reconstruction. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi180030-7">  </a> <h5 class="section-title" id="d943897e378">Conclusions and Relevance</h5> <p id="d943897e380">At 2 years, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial well-being and sexual well-being than did those who underwent implant reconstruction. These findings can inform patients and their clinicians about expected satisfaction and quality of life outcomes of autologous vs implant-based procedures and further support the adoption of shared decision making in clinical practice. </p> </div><p class="first" id="d943897e383">This multicenter cohort study compares satisfaction and breast-related quality of life reported by patients undergoing breast implant reconstruction or autologous tissue reconstruction 2 years after surgery. </p><div class="section"> <a class="named-anchor" id="ab-soi180030-8">  </a> <h5 class="section-title" id="d943897e389">Question</h5> <p id="d943897e391">How do satisfaction and breast-related quality of life differ between patients undergoing implant-based vs autologous immediate breast reconstruction at 2 years after surgery? </p> </div><div class="section"> <a class="named-anchor" id="ab-soi180030-9">  </a> <h5 class="section-title" id="d943897e394">Findings</h5> <p id="d943897e396">In this multicenter cohort study, patients who underwent autologous reconstruction reported significantly greater satisfaction with their breasts (BREAST-Q score difference, 7.94), psychosocial well-being (difference, 3.23), and sexual well-being (difference, 5.53) at 2 years compared with patients who underwent implant reconstruction. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi180030-10">  </a> <h5 class="section-title" id="d943897e399">Meaning</h5> <p id="d943897e401">At 2 years after reconstruction, patients who underwent autologous reconstruction reported significantly greater satisfaction and breast-related quality of life compared with patients who underwent implant-based techniques. </p> </div>

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Most cited references 27

Record: found
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Nationwide trends in mastectomy for early-stage breast cancer.

Kristy L Kummerow, Liping Du, David Penson … (2015)

Accredited breast centers in the United States are measured on performance of breast conservation surgery (BCS) in the majority of women with early-stage breast cancer. Prior research in regional and limited national cohorts suggests a recent shift toward increasing performance of mastectomy in patients eligible for BCS.

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Record: found
Abstract: found
Article: not found

Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment.

J. D. Morris, Bianca Habermann, Beth Virnig … (2007)

Many patients with unilateral breast cancer choose contralateral prophylactic mastectomy to prevent cancer in the opposite breast. The purpose of our study was to determine the use and trends of contralateral prophylactic mastectomy in the United States. We used the Surveillance, Epidemiology and End Results database to review the treatment of patients with unilateral breast cancer diagnosed from 1998 through 2003. We determined the rate of contralateral prophylactic mastectomy as a proportion of all surgically treated patients and as a proportion of all mastectomies. We identified 152,755 patients with stage I, II, or III breast cancer; 4,969 patients chose contralateral prophylactic mastectomy. The rate was 3.3% for all surgically treated patients; 7.7%, for patients undergoing mastectomy. The overall rate significantly increased from 1.8% in 1998 to 4.5% in 2003. Likewise, the contralateral prophylactic mastectomy rate for patients undergoing mastectomy significantly increased from 4.2% in 1998 to 11.0% in 2003. These increased rates applied to all cancer stages and continued to the end of our study period. Young patient age, non-Hispanic white race, lobular histology, and previous cancer diagnosis were associated with significantly higher rates. Large tumor size was associated with a higher overall rate, but with a lower rate for patients undergoing mastectomy. The use of contralateral prophylactic mastectomy in the United States more than doubled within the recent 6-year period of our study. Prospective studies are needed to understand the decision-making processes that have led to more aggressive breast cancer surgery.

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Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States.

Reshma Jagsi, Jeffrey Smith, T Buchholz … (2014)

Concerns exist regarding breast cancer patients' access to breast reconstruction, which provides important psychosocial benefits. Using the MarketScan database, a claims-based data set of US patients with employment-based insurance, we identified 20,560 women undergoing mastectomy for breast cancer from 1998 to 2007. We evaluated time trends using the Cochran-Armitage test and correlated reconstruction use with plastic-surgery workforce density and other treatments using multivariable regression. Median age of our sample was 51 years. Reconstruction use increased from 46% in 1998 to 63% in 2007 (P < .001), with increased use of implants and decreased use of autologous techniques over time (P < .001). Receipt of bilateral mastectomy also increased: from 3% in 1998 to 18% in 2007 (P < .001). Patients receiving bilateral mastectomy were more likely to receive reconstruction (odds ratio [OR], 2.3; P < .001) and patients receiving radiation were less likely to receive reconstruction (OR, 0.44; P < .001). Rates of reconstruction receipt varied dramatically by geographic region, with associations with plastic surgeon density in each state and county-level income. Autologous techniques were more often used in patients who received both reconstruction and radiation (OR, 1.8; P < .001) and less frequently used in patients with capitated insurance (OR, 0.7; P < .001), patients undergoing bilateral mastectomy (OR, 0.5; P < .001), or patients in the highest income quartile (OR, 0.7; P = .006). Delayed reconstruction was performed in 21% of patients who underwent reconstruction. Breast reconstruction has increased over time, but it has wide geographic variability. Receipt of other treatments correlates with the use of and approaches toward reconstruction. Further research and interventions are needed to ensure equitable access to this important component of multidisciplinary treatment of breast cancer.