Breast Reconstruction Implant Type Impacts Patient Satisfaction Reported by the Breast-Q
Charalampos Siotos, MD, Ricardo J. Bello, MD, MPH, Mohamad E. Sebai, MBBS, Eric L. Wan, BS, Jeffrey W. Aston, BS, Julie Lee, Sethly Davis, David Cui, Justin M. Sacks, MD, MBA, Michele A. Manahan, MD, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.
BACKGROUND: Rates of breast reconstruction are consistently increasing over time. As of 2008, nearly a quarter of all women undergoing mastectomy for treatment of breast cancer seek implant-based breast reconstruction. Patients and providers should be aware of patient-reported differences in satisfaction and quality of life associated with different types of implants in order to make informed decisions regarding their treatment. We investigated whether patients who receive saline or silicone breast implants as a part of their breast reconstruction report different satisfaction and quality of life scores.
METHODS: Using our IRB-approved, prospectively collected breast reconstruction patient registry, we queried pre- and post-operative data from patients who underwent breast reconstruction with saline or silicone implants at our institution. Data of interest included patient-reported satisfaction and quality of life outcomes using the Breast-Q reconstruction module. Breast-Q data were collected before mastectomy and reconstruction and at 12-months post-final reconstruction. To assess the association between the type of breast implant and Breast-Q outcomes, we conducted multiple linear regression analysis adjusting for age, BMI, timing of breast reconstruction, laterality, post-mastectomy radiotherapy, and postoperative chemotherapy.
RESULTS: Between 2010 and 2015, 124 patients were eligible for study inclusion: 31 (25%) women underwent saline implant-based reconstruction and 93 (75%) underwent silicone implant-based reconstruction. Pre-operative Breast-Q values were statistically comparable for all Breast-Q domains with no statistically significant differences between the two groups. Patients who received saline implants reported higher median Breast-Q scores 12-months post-final breast reconstruction for the domains of Psychosocial Well-Being (saline: 84, IQR=52.5-86.7 vs silicone: 76, IQR=54.1-92) and Physical Well-Being: Chest and Upper Body (saline: 85, IQR=57-85 vs silicone: 77, IQR=66-91). These differences were statistically significant only for the Psychosocial Well-Being domain (adjusted analysis; 95% CI: -20.85, -1.15; p=0.029). Patients with silicone implants reported higher median scores for Satisfaction with Breasts (saline: 61, IQR=44.2-68.6 vs silicone: 62, IQR=48.1-7), Sexual Well-Being (saline: 54, IQR=38.2-59.3 vs silicone: 57, IQR=40.54-63). However, these differences were not statistically significant. Post-operative complications were not significantly different between study groups.
CONCLUSIONS: Our results suggest that patients receiving breast reconstruction with saline and silicone implants report same or similar long-term patient-reported satisfaction and quality of life. Interestingly, scores for the Psychosocial Well-Being domain were higher in the saline implant patients; however, possible clinical causes for this are not clear. A previous cross-sectional study showed that most domains were higher in silicone implant patients. To our knowledge, our study is the first cohort study evaluating this relationship. Future prospective studies with larger sample sizes are clearly necessary to further clarify the effect of the type of implant on patient quality of life and satisfaction associated with breast reconstruction.
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