Laterality and patient-reported satisfaction following autologous breast reconstruction with abdominal tissue: an 8 year examination of BREAST-Q data.
Nikhil Sobti, BA1, Jonas A. Nelson, MD1, Aadit R. Patel, MD, MS1, Evan Matros, MD, MMSc, MPH1, Colleen M. McCarthy, MD, MS1, Joseph H. Dayan, MD1, Joseph J. Disa, MD1, Peter G. Cordeiro, MD1, Babak J. Mehrara, MD1, Monica Morrow, MD1, Andrea L. Pusic, MD, MHS2, Robert J. Allen, Jr., MD1.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Brigham and Women's Hospital, Boston, MA, USA.
BACKGROUND: Despite the increasing prevalence of contralateral prophylactic mastectomy (CPM), few studies have evaluated patient-reported outcomes to assess patient satisfaction between unilateral and bilateral autologous breast reconstruction. Our study aims to investigate the association between patient satisfaction and laterality to guide clinical decision-making. We hypothesize that patient satisfaction will not differ significantly between unilateral and bilateral autologous breast reconstruction with abdominally-based free flaps.
METHODS: An IRB approved investigation was conducted to evaluate patients undergoing autologous breast reconstruction at Memorial Sloan Kettering Cancer Center. Since 2009, patients have completed the BREAST-Q as part of their standard of care in reconstruction. In the present study, the reconstruction module was used to assess patient-reported outcomes between unilateral and bilateral autologous reconstruction patients, with a focus on satisfaction with breasts and abdominal well-being.
RESULTS: Overall, 405 patients who underwent autologous breast reconstruction completed the BREAST-Q during the follow up period. Two hundred and thirty four (57.8%) patients underwent bilateral reconstruction, whereas the remaining 171 underwent unilateral reconstruction. Interval of follow-up was well-matched between unilateral and bilateral mastectomy cohorts (mean, 2.6 ± 2.2 years v. mean, 2.5 ± 2.2 years, respectively, p = 0.21). Cross-sectional analysis at 1-year, 2-years, and 3-years revealed no statistically significant difference in satisfaction with breast or overall well-being between groups. Similarly, no significant differences were noted at years 4-10 in satisfaction with breast, though small sample size limited these analyses. Bilateral reconstruction patients, however, reported significantly lower abdominal well being at 1-year, 2-years, and > 3-years (p = 0.01, p = 0.03, and p = 0.01 respectively). Change in satisfaction from baseline between laterality groups did not differ significantly at the aforementioned time intervals.
CONCLUSIONS: This work uniquely compares patient satisfaction following autologous breast reconstruction with abdominal tissue transfer between unilateral and bilateral mastectomy cohorts. These results suggest that satisfaction does not differ between unilateral and bilateral reconstructions through 3-years postoperatively. Conversely, there was decreased abdominal well-being following bilateral reconstruction early in the interval of observation. These data can be utilized in preoperative counseling, informed consent, and expectations management in patients considering CPM and subsequent bilateral reconstruction.
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