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Published in: Archives of Gynecology and Obstetrics 3/2013

01-03-2013 | Gynecologic Oncology

A retrospective investigation of women’s experience with breast reconstruction after mastectomy

Authors: Nina Ditsch, Ingo Bauerfeind, Andrea Vodermaier, Christina Tripp, Bettina Löhrs, Bettina Toth, Isabelle Himsl, Monika Graeser, Nadia Harbeck, Miriam Lenhard

Published in: Archives of Gynecology and Obstetrics | Issue 3/2013

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Abstract

Purpose

A diagnosis of breast cancer is often accompanied by the fear of loss of previous body image and attractiveness. Hence, many patients opt for reconstructive surgery. This study evaluated the effects of different types of reconstructive surgery after mastectomy on the functional and psychological adjustment of patients.

Methods

In a cohort study, patients, who had breast reconstruction after mastectomy by means of four different allogenic or autologues techniques between 1999–2006 were retrospectively interviewed in person or by telephone. The questions addressed complication rates, physical complaints, functional impairments, body image outcomes, sexuality and patient satisfaction.

Results

Of 139 patients, 89 (64.7 %) completed the survey. 32 (35.9 %) patients experienced one or more postoperative complications like seroma, hematoma, infections or necrosis. 16 (20 %) and 13 (16 %) patients reported strong and moderate adverse effects on sexuality, respectively. 62 (70 %) patients indicated that they were actively included in the decision making process. Patient ratings of good or bad medical advice were associated with complication rates (p = 0.008). Patients, who evaluated their first preoperative counseling positively, reported higher consent rates when a re-reconstruction became necessary (p ≤ 0.001). Satisfaction with the functional outcome after reconstruction and satisfaction with the cosmetic result was highly correlated (p < 0.001).

Conclusions

A significant association of patient satisfaction with postoperative complications and the decision for a re-reconstruction was demonstrated. Furthermore, our results emphasize the importance of detailed preoperative counseling for women’s adjustment to reconstructive surgery.
Literature
1.
go back to reference Schrodi S, Engel J, Heywang-Köbrunner SH, Schubert-Fritschle G (2011) Epidemiologie. Tumorzentrum München, Manual Mammakarzinome 13:1–11 Schrodi S, Engel J, Heywang-Köbrunner SH, Schubert-Fritschle G (2011) Epidemiologie. Tumorzentrum München, Manual Mammakarzinome 13:1–11
2.
go back to reference Untch M (2008) Diagnostik und Therapie der Mammakarzinoms. State of the art 249–260 Untch M (2008) Diagnostik und Therapie der Mammakarzinoms. State of the art 249–260
3.
go back to reference Riedner C, Haidinger R, Hermelink K, Köhm J (2011) Psychoonkologische Gesichtspunkte. Tumorzentrum München, Manual Mammakarzinome 13. Auflage 225–242 Riedner C, Haidinger R, Hermelink K, Köhm J (2011) Psychoonkologische Gesichtspunkte. Tumorzentrum München, Manual Mammakarzinome 13. Auflage 225–242
4.
go back to reference Fobair P et al (2006) Body image and sexual problems in young women with breast cancer. Psychooncology 15(7):579–594PubMedCrossRef Fobair P et al (2006) Body image and sexual problems in young women with breast cancer. Psychooncology 15(7):579–594PubMedCrossRef
5.
go back to reference Schover LR (1994) Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr 16:177–82 Schover LR (1994) Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr 16:177–82
6.
go back to reference Dian D, Anthuber A, Bauerfeind I, Beyreuther HJ, Braun M et al (2011) Operative Therapie des primären Mammakarzinoms und Rekonstruktionsverfahren. Tumorzentrum München, Manual Mammakarzinome 13. Auflage 121–123 Dian D, Anthuber A, Bauerfeind I, Beyreuther HJ, Braun M et al (2011) Operative Therapie des primären Mammakarzinoms und Rekonstruktionsverfahren. Tumorzentrum München, Manual Mammakarzinome 13. Auflage 121–123
7.
go back to reference Hopwood P et al (2001) A body image scale for use with cancer patients. Eur J Cancer 37(2):189–197PubMedCrossRef Hopwood P et al (2001) A body image scale for use with cancer patients. Eur J Cancer 37(2):189–197PubMedCrossRef
10.
go back to reference Handel N, Silverstein MJ (2006) Breast cancer diagnosis and prognosis in augmented women. Plast Reconstr Surg 118(3):587–593 (discussion 594–6)PubMedCrossRef Handel N, Silverstein MJ (2006) Breast cancer diagnosis and prognosis in augmented women. Plast Reconstr Surg 118(3):587–593 (discussion 594–6)PubMedCrossRef
11.
go back to reference Munhoz AM et al (2005) Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. Plast Reconstr Surg 116(3):741–752PubMedCrossRef Munhoz AM et al (2005) Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. Plast Reconstr Surg 116(3):741–752PubMedCrossRef
12.
go back to reference Chang DW et al (2000) Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 105(5):1640–1648PubMedCrossRef Chang DW et al (2000) Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 105(5):1640–1648PubMedCrossRef
13.
go back to reference Garbay JR, Rietjens M, Petit JY (1992) Esthetic results of breast reconstruction after amputation for cancer. 323 cases. J Gynecol Obstet Biol Reprod (Paris) 21(4):405–412 Garbay JR, Rietjens M, Petit JY (1992) Esthetic results of breast reconstruction after amputation for cancer. 323 cases. J Gynecol Obstet Biol Reprod (Paris) 21(4):405–412
14.
go back to reference Alderman AK et al (2002) Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 109(7):2265–2274PubMedCrossRef Alderman AK et al (2002) Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 109(7):2265–2274PubMedCrossRef
15.
go back to reference Bresser PJ et al (2006) Satisfaction with prophylactic mastectomy and breast reconstruction in genetically predisposed women. Plast Reconstr Surg 117(6):1675–1682 (discussion 1683–4)PubMedCrossRef Bresser PJ et al (2006) Satisfaction with prophylactic mastectomy and breast reconstruction in genetically predisposed women. Plast Reconstr Surg 117(6):1675–1682 (discussion 1683–4)PubMedCrossRef
16.
go back to reference Saulis AS, Mustoe TA, Fine NA (2007) A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures. Plast Reconstr Surg 119(6):1669–1676 (discussion 1677–8)PubMedCrossRef Saulis AS, Mustoe TA, Fine NA (2007) A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures. Plast Reconstr Surg 119(6):1669–1676 (discussion 1677–8)PubMedCrossRef
17.
go back to reference Krueger EA et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49(3):713–721PubMedCrossRef Krueger EA et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49(3):713–721PubMedCrossRef
18.
go back to reference Rosenqvist S, Sandelin K, Wickman M (1996) Patients’ psychological and cosmetic experience after immediate breast reconstruction. Eur J Surg Oncol 22(3):262–266PubMedCrossRef Rosenqvist S, Sandelin K, Wickman M (1996) Patients’ psychological and cosmetic experience after immediate breast reconstruction. Eur J Surg Oncol 22(3):262–266PubMedCrossRef
19.
go back to reference Dian D et al (2007) Aesthetic result among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy. Arch Gynecol Obstet 275(6):445–450PubMedCrossRef Dian D et al (2007) Aesthetic result among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy. Arch Gynecol Obstet 275(6):445–450PubMedCrossRef
20.
go back to reference Gerber B et al (2009) The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 249(3):461–468PubMedCrossRef Gerber B et al (2009) The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 249(3):461–468PubMedCrossRef
21.
go back to reference Tarantino I, Banic A, Fischer T (2006) Evaluation of late results in breast reconstruction by latissimus dorsi flap and prosthesis implantation. Plast Reconstr Surg 117(5):1387–1394PubMedCrossRef Tarantino I, Banic A, Fischer T (2006) Evaluation of late results in breast reconstruction by latissimus dorsi flap and prosthesis implantation. Plast Reconstr Surg 117(5):1387–1394PubMedCrossRef
22.
go back to reference Andrade WN, Semple JL (2006) Patient self-assessment of the cosmetic results of breast reconstruction. Plast Reconstr Surg 117(1):44–47 (discussion 48–9)PubMedCrossRef Andrade WN, Semple JL (2006) Patient self-assessment of the cosmetic results of breast reconstruction. Plast Reconstr Surg 117(1):44–47 (discussion 48–9)PubMedCrossRef
23.
go back to reference Fee-Fulkerson K et al (1996) Factors contributing to patient satisfaction with breast reconstruction using silicone gel implants. Plast Reconstr Surg 97(7):1420–1426PubMedCrossRef Fee-Fulkerson K et al (1996) Factors contributing to patient satisfaction with breast reconstruction using silicone gel implants. Plast Reconstr Surg 97(7):1420–1426PubMedCrossRef
24.
go back to reference Cederna PS et al (1995) Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous flap versus breast implant reconstruction. Ann Plast Surg 35(5):458–468PubMedCrossRef Cederna PS et al (1995) Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous flap versus breast implant reconstruction. Ann Plast Surg 35(5):458–468PubMedCrossRef
25.
go back to reference Franchelli S et al (1995) Psychological evaluation of patients undergoing breast reconstruction using two different methods: autologous tissues versus prostheses. Plast Reconstr Surg 95(7):1213–1218 (discussion 1219–20)PubMedCrossRef Franchelli S et al (1995) Psychological evaluation of patients undergoing breast reconstruction using two different methods: autologous tissues versus prostheses. Plast Reconstr Surg 95(7):1213–1218 (discussion 1219–20)PubMedCrossRef
26.
go back to reference Metcalfe KA, Semple J, Quan ML, Vadaparampil ST, Holloway C, Brown M, Bower B, Sun P, Narod SA (2012) Changes in psychosocial functioning 1 year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction. Ann Surg Oncol 19(1):233–241PubMedCrossRef Metcalfe KA, Semple J, Quan ML, Vadaparampil ST, Holloway C, Brown M, Bower B, Sun P, Narod SA (2012) Changes in psychosocial functioning 1 year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction. Ann Surg Oncol 19(1):233–241PubMedCrossRef
27.
go back to reference Brandberg Y, Malm M, Blomqvist L (2000) A prospective and randomized study, “SVEA,” comparing effects of three methods for delayed breast reconstruction on quality of life, patient-defined problem areas of life, and cosmetic result. Plast Reconstr Surg 105(1):66–74 (discussion 75–6)PubMedCrossRef Brandberg Y, Malm M, Blomqvist L (2000) A prospective and randomized study, “SVEA,” comparing effects of three methods for delayed breast reconstruction on quality of life, patient-defined problem areas of life, and cosmetic result. Plast Reconstr Surg 105(1):66–74 (discussion 75–6)PubMedCrossRef
28.
go back to reference Guyomard V, Leinster S, Wilkinson M (2007) Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy. Breast 16(6):547–567PubMedCrossRef Guyomard V, Leinster S, Wilkinson M (2007) Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy. Breast 16(6):547–567PubMedCrossRef
29.
go back to reference Guyomard V, Leinster S, Wilkinson M, Servant JM, Pereira J (2009) A Franco-British patients’ and partners’ satisfaction audit of breast reconstruction. J Plast Reconstr Aesthet Surg 62:782–789PubMedCrossRef Guyomard V, Leinster S, Wilkinson M, Servant JM, Pereira J (2009) A Franco-British patients’ and partners’ satisfaction audit of breast reconstruction. J Plast Reconstr Aesthet Surg 62:782–789PubMedCrossRef
30.
go back to reference Alderman AK et al (2000) Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 106(4):769–776PubMed Alderman AK et al (2000) Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 106(4):769–776PubMed
31.
go back to reference Shaikh-Naidu N et al (2004) Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction. Ann Plast Surg 52(5):465–470 (discussion 470)PubMedCrossRef Shaikh-Naidu N et al (2004) Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction. Ann Plast Surg 52(5):465–470 (discussion 470)PubMedCrossRef
32.
go back to reference Edsander-Nord A, Brandberg Y, Wickman M (2001) Quality of life, patients’ satisfaction, and aesthetic outcome after pedicled or free TRAM flap breast surgery. Plast Reconstr Surg 107(5):1142–1153 (discussion 1154–5)PubMedCrossRef Edsander-Nord A, Brandberg Y, Wickman M (2001) Quality of life, patients’ satisfaction, and aesthetic outcome after pedicled or free TRAM flap breast surgery. Plast Reconstr Surg 107(5):1142–1153 (discussion 1154–5)PubMedCrossRef
33.
go back to reference Ramon Y et al (1997) Aesthetic results and patient satisfaction with immediate breast reconstruction using tissue expansion: a follow-up study. Plast Reconstr Surg 99(3):686–691PubMedCrossRef Ramon Y et al (1997) Aesthetic results and patient satisfaction with immediate breast reconstruction using tissue expansion: a follow-up study. Plast Reconstr Surg 99(3):686–691PubMedCrossRef
34.
go back to reference Gerber B et al (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238(1):120–127PubMed Gerber B et al (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238(1):120–127PubMed
35.
go back to reference Rowland JH et al (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92(17):1422–1429PubMedCrossRef Rowland JH et al (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92(17):1422–1429PubMedCrossRef
37.
go back to reference Contant CM et al (2000) Motivations, satisfaction, and information of immediate breast reconstruction following mastectomy. Patient Educ Couns 40(3):201–208PubMedCrossRef Contant CM et al (2000) Motivations, satisfaction, and information of immediate breast reconstruction following mastectomy. Patient Educ Couns 40(3):201–208PubMedCrossRef
38.
go back to reference Keating NL et al (2003) Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed? Breast Cancer Res Treat 79(2):225–231PubMedCrossRef Keating NL et al (2003) Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed? Breast Cancer Res Treat 79(2):225–231PubMedCrossRef
39.
go back to reference Sheehan J et al (2007) Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction. Psychooncology 16(4):342–351PubMedCrossRef Sheehan J et al (2007) Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction. Psychooncology 16(4):342–351PubMedCrossRef
40.
go back to reference Vodermaier A, Caspari C, Wang L, Köhm J, Ditsch N, Untch M (2011) How and for whom are decision aids effective? Long-term psychological outcome of a randomized controlled trial in women with newly diagnosed breast cancer. Health Psychol 30(1):12–19PubMedCrossRef Vodermaier A, Caspari C, Wang L, Köhm J, Ditsch N, Untch M (2011) How and for whom are decision aids effective? Long-term psychological outcome of a randomized controlled trial in women with newly diagnosed breast cancer. Health Psychol 30(1):12–19PubMedCrossRef
Metadata
Title
A retrospective investigation of women’s experience with breast reconstruction after mastectomy
Authors
Nina Ditsch
Ingo Bauerfeind
Andrea Vodermaier
Christina Tripp
Bettina Löhrs
Bettina Toth
Isabelle Himsl
Monika Graeser
Nadia Harbeck
Miriam Lenhard
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Archives of Gynecology and Obstetrics / Issue 3/2013
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-012-2590-1

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