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01-07-2014 | Clinical Trial

Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q

Authors: Chunjun Liu, Yan Zhuang, Arash Momeni, Jie Luan, Michael T. Chung, Eric Wright, Gordon K. Lee

Published in: Breast Cancer Research and Treatment | Issue 1/2014

Abstract

Staged expander–implant breast reconstruction (EIBR) and microsurgical abdominal flap breast reconstruction (MAFBR) are the most common modes of breast reconstruction (BR) in the United States. Whether the mode of breast reconstruction has an impact on patient quality of life (QoL) and satisfaction remains a question. A retrospective study was conducted identifying a population of 119 patients who underwent unilateral immediate BR. Only patients who were eligible for either EIBR or MAFBR based on preoperative characteristics were included in the study. The following parameters were retrieved: demographics, mode of reconstruction, cancer, recovery, QoL, and patient satisfaction. The latter two parameters were determined using the BREAST-Q BR module questionnaire. Two-way analysis of variance with mode of reconstruction and occurrence of complication as independent variables was used to determine the effect on patient satisfaction and QoL. The association between mode of reconstruction and patient response with each item of the QoL and satisfaction survey domains was analyzed. The overall response rate was 62.2 %. Non-respondents and respondents did not significantly differ in demographics, surgery type, cancer staging, adjuvant therapy, and complication rate. Age and BMI were significantly higher in MAFBR, while level of education was higher in EIBR. MAFBR had higher scores in psychosocial and sexual wellbeing, satisfaction with outcome, breast, information, and plastic surgeon when compared with patients who underwent EIBR. For patients eligible for both MAFBR and EIBR, MAFBR is associated with higher levels of satisfaction and QoL. Comprehensive pre-operative information of pros and cons of both modes of BR is crucial for patients to make a well-informed decision, thus, resulting in higher levels of satisfaction.

American Society of Plastic Surgeons 2012 Plastic Surgery Statistics Report (2013) http://www.plasticsurgery.org/Documents/news-resources/statistics/2012-Plastic-Surgery-Statistics/full-plastic-surgery-statistics-report.pdf

Liu C, Momeni A, Zhuang Y, Luan J, Chung MT, Wright E, Lee GK (2014) Outcome analysis of expander/implant versus microsurgical abdominal flap breast reconstruction: a critical study of 254 cases. Ann Surg Oncol. doi:10.1245/s10434-014-3521-0

Health USDo, Human Services FDACfDE, Research, Health USDo, Human Services FDACfBE, Research, Health USDo, Human Services FDACfD, Radiological H (2006) Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health and quality of life outcomes 4:79. doi:10.1186/1477-7525-4-79

Lee C, Sunu C, Pignone M (2009) Patient-reported outcomes of breast reconstruction after mastectomy: a systematic review. J Am Coll Surg 209(1):123–133. doi:10.1016/j.jamcollsurg.2009.02.061 PubMedCentralPubMedCrossRef

Blazeby JM, Avery K, Sprangers M, Pikhart H, Fayers P, Donovan J (2006) Health-related quality of life measurement in randomized clinical trials in surgical oncology. J Clin Oncol: official journal of the American Society of Clinical Oncology 24(19):3178–3186. doi:10.1200/JCO.2005.05.2951 CrossRef

Winters ZE, Benson JR, Pusic AL (2010) A systematic review of the clinical evidence to guide treatment recommendations in breast reconstruction based on patient- reported outcome measures and health-related quality of life. Ann Surg 252(6):929–942. doi:10.1097/SLA.0b013e3181e623db PubMedCrossRef

Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ (2009) Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 124(2):345–353. doi:10.1097/PRS.0b013e3181aee807 PubMedCrossRef

Lowe HJ, Ferris TA, Hernandez PM, Weber SC (2009) STRIDE—an integrated standards-based translational research informatics platform. AMIA Annual Symposium proceedings/AMIA Symposium 2009:391–395

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. doi:10.1016/j.jbi.2008.08.010 PubMedCentralPubMedCrossRef

10.

Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL (2012) The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg 129(2):293–302. doi:10.1097/PRS.0b013e31823aec6b PubMedCrossRef

11.

Cano SJ, Klassen AF, Scott AM, Pusic AL (2013) A closer look at the BREAST-Q(c). Clin Plast Surg 40(2):287–296. doi:10.1016/j.cps.2012.12.002 PubMedCrossRef

12.

Sugrue R, MacGregor G, Sugrue M, Curran S, Murphy L (2013) An evaluation of patient reported outcomes following breast reconstruction utilizing Breast Q. Breast 22(2):158–161. doi:10.1016/j.breast.2012.12.001 PubMedCrossRef

13.

Zhong T, Temple-Oberle C, Hofer S, Beber B, Semple J, Brown M, Macadam S, Lennox P, Panzarella T, McCarthy C, Baxter N (2013) The Multi Centre Canadian Acellular Dermal Matrix Trial (MCCAT): study protocol for a randomized controlled trial in implant-based breast reconstruction. Trials 14(1):356. doi:10.1186/1745-6215-14-356 PubMedCentralPubMedCrossRef

14.

Zhong T, McCarthy C, Min S, Zhang J, Beber B, Pusic AL, Hofer SO (2012) Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer 118(6):1701–1709. doi:10.1002/cncr.26417 PubMedCrossRef

15.

Peled AW, Duralde E, Foster RD, Fiscalini AS, Esserman LJ, Hwang ES, Sbitany H (2013) Patient-reported outcomes and satisfaction after total skin-sparing mastectomy and immediate expander–implant reconstruction. Ann Plast Surg. doi:10.1097/SAP.0000000000000020

16.

Macadam SA, Ho AL, Lennox PA, Pusic AL (2013) Patient-reported satisfaction and health-related quality of life following breast reconstruction: a comparison of shaped cohesive gel and round cohesive gel implant recipients. Plast Reconstr Surg 131(3):431–441. doi:10.1097/PRS.0b013e31827c6d55 PubMedCrossRef

17.

Eltahir Y, Werners LL, Dreise MM, van Emmichoven IA, Jansen L, Werker PM, de Bock GH (2013) Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg 132(2):201e–209e. doi:10.1097/PRS.0b013e31829586a7 PubMedCrossRef

18.

Sprangers MA, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, Franzini L, Williams A, de Haes HC, Hopwood P, Cull A, Aaronson NK (1996) The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol: official journal of the American Society of Clinical Oncology 14(10):2756–2768

19.

Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G (1997) Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol: official journal of the American Society of Clinical Oncology 15(3):974–986

20.

Gopie JP, Hilhorst MT, Kleijne A, Timman R, Menke-Pluymers MB, Hofer SO, Mureau MA, Tibben A (2011) Women’s motives to opt for either implant or DIEP-flap breast reconstruction. J Plast Reconstr Aesthet Surg JPRAS 64(8):1062–1067. doi:10.1016/j.bjps.2011.03.030 CrossRef

21.

Sbitany H, Amalfi AN, Langstein HN (2009) Preferences in choosing between breast reconstruction options: a survey of female plastic surgeons. Plast Reconstr Surg 124(6):1781–1789. doi:10.1097/PRS.0b013e3181bf8056 PubMedCrossRef

22.

Gopie JP, Ter Kuile MM, Timman R, Mureau MA, Tibben A (2013) Impact of delayed implant and DIEP flap breast reconstruction on body image and sexual satisfaction: a prospective follow-up study. Psycho Oncol. doi:10.1002/pon.3377

23.

Al-Ghazal SK, Fallowfield L, Blamey RW (2000) Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 36(15):1938–1943PubMedCrossRef

24.

Dean C, Chetty U, Forrest AP (1983) Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1(8322):459–462PubMedCrossRef

25.

Elder EE, Brandberg Y, Bjorklund T, Rylander R, Lagergren J, Jurell G, Wickman M, Sandelin K (2005) Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast 14(3):201–208. doi:10.1016/j.breast.2004.10.008 PubMedCrossRef

26.

Metcalfe KA, Semple JL, Narod SA (2004) Satisfaction with breast reconstruction in women with bilateral prophylactic mastectomy: a descriptive study. Plast Reconstr Surg 114(2):360–366PubMedCrossRef

27.

Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92(17):1422–1429PubMedCrossRef

28.

Alderman AK, Kuhn LE, Lowery JC, Wilkins EG (2007) Does patient satisfaction with breast reconstruction change over time? Two-year results of the Michigan Breast Reconstruction Outcomes Study. J Am Coll Surg 204(1):7–12. doi:10.1016/j.jamcollsurg.2006.09.022 PubMedCrossRef

29.

Alderman AK, Wilkins EG, Lowery JC, Kim M, Davis JA (2000) Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 106(4):769–776PubMedCrossRef

30.

Giacalone PL, Bricout N, Dantas MJ, Daures JP, Laffargue F (2002) Achieving symmetry in unilateral breast reconstruction: 17 years experience with 683 patients. Aesthet Plast Surg 26(4):299–302. doi:10.1007/s00266-002-2034-6 CrossRef

31.

Hu ES, Pusic AL, Waljee JF, Kuhn L, Hawley ST, Wilkins E, Alderman AK (2009) Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Period. Plast Reconstr Surg 124(1):1–8. doi:10.1097/PRS.0b013e3181ab10b2 PubMedCrossRef

32.

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. doi:10.1097/01.prs.0000258827.21635.84 discussion 1677–1668PubMedCrossRef

33.

Spear SL, Newman MK, Bedford MS, Schwartz KA, Cohen M, Schwartz JS (2008) A retrospective analysis of outcomes using three common methods for immediate breast reconstruction. Plast Reconstr Surg 122(2):340–347. doi:10.1097/PRS.0b013e31817d6009 PubMedCrossRef

34.

Tonseth KA, Hokland BM, Tindholdt TT, Abyholm FE, Stavem K (2008) Quality of life, patient satisfaction and cosmetic outcome after breast reconstruction using DIEP flap or expandable breast implant. J Plast Reconstr Aesthet Surg JPRAS 61(10):1188–1194. doi:10.1016/j.bjps.2007.05.006 CrossRef

35.

Yueh JH, Slavin SA, Adesiyun T, Nyame TT, Gautam S, Morris DJ, Tobias AM, Lee BT (2010) Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 125(6):1585–1595. doi:10.1097/PRS.0b013e3181cb6351 PubMedCrossRef

36.

Ho AL, Klassen AF, Cano S, Scott AM, Pusic AL (2013) Optimizing patient-centered care in breast reconstruction: the importance of preoperative information and patient-physician communication. Plast Reconstr Surg 132(2):212e–220e. doi:10.1097/PRS.0b013e31829586fa PubMedCrossRef

37.

Sheehan J, Sherman KA, Lam T, Boyages J (2007) Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction. Psycho Oncol 16(4):342–351. doi:10.1002/pon.1067 CrossRef

38.

Gopie JP, Timman R, Hilhorst MT, Hofer SO, Mureau MA, Tibben A (2011) Information-seeking behaviour and coping style of women opting for either implant or DIEP-flap breast reconstruction. J Plast Reconstr Aesthet Surg JPRAS 64(9):1167–1173. doi:10.1016/j.bjps.2011.03.034 CrossRef

39.

Bresser PJ, Seynaeve C, Van Gool AR, Brekelmans CT, Meijers-Heijboer H, van Geel AN, Menke-Pluijmers MB, Duivenvoorden HJ, Klijn JG, Tibben A (2006) Satisfaction with prophylactic mastectomy and breast reconstruction in genetically predisposed women. Plast Reconstr Surg 117(6):1675–1682. doi:10.1097/01.prs.0000217383.99038.f5 discussion 1683-1674PubMedCrossRef

40.

Snell L, McCarthy C, Klassen A, Cano S, Rubin L, Hurley K, Montgomery GH, Cordeiro PG, Pusic A (2010) Clarifying the expectations of patients undergoing implant breast reconstruction: a qualitative study. Plast Reconstr Surg 126(6):1825–1830. doi:10.1097/PRS.0b013e3181f44580 PubMedCrossRef

41.

Hoppe IC, Ahuja NK, Ingargiola MJ, Granick MS (2013) A survey of patient comprehension of readily accessible online educational material regarding plastic surgery procedures. Aesthet Surg J/Am Soc Aesthet Plast Surg 33(3):436–442. doi:10.1177/1090820X13480013 CrossRef

42.

Tan ML, Kok K, Ganesh V, Thomas SS (2014) Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com. Breast 23(1):33–37. doi:10.1016/j.breast.2013.10.003 PubMedCrossRef

43.

Losken A, Burke R, Elliott LF 2nd, Carlson GW (2005) Infonomics and breast reconstruction: are patients using the internet? Ann Plast Surg 54(3):247–250PubMed

44.

Macdonald C, Lloyd MS, Mathur B, Ramakrishnan V (2010) Breast reconstruction: a quantitative assessment of the quality of information available to patients. J Plast Reconstr Aesthet Surg JPRAS 63(10):e752–e753. doi:10.1016/j.bjps.2010.05.031 CrossRef

45.

Lam WW, Chan M, Or A, Kwong A, Suen D, Fielding R (2013) Reducing treatment decision conflict difficulties in breast cancer surgery: a randomized controlled trial. J Clin Oncol official journal of the American Society of Clinical Oncology 31(23):2879–2885. doi:10.1200/JCO.2012.45.1856 CrossRef

46.

Lam W, Fielding R, Chan M, Chow L, Ho E (2003) Participation and satisfaction with surgical treatment decision-making in breast cancer among Chinese women. Breast Cancer Res Treat 80(2):171–180. doi:10.1023/A:1024568732213 PubMedCrossRef

47.

Drug, Therapeutics B (2013) An introduction to patient decision aids. BMJ 347:f4147. doi:10.1136/bmj.f4147 CrossRef

48.

Elwyn G, O’Connor A, Stacey D, Volk R, Edwards A, Coulter A, Thomson R, Barratt A, Barry M, Bernstein S, Butow P, Clarke A, Entwistle V, Feldman-Stewart D, Holmes-Rovner M, Llewellyn-Thomas H, Moumjid N, Mulley A, Ruland C, Sepucha K, Sykes A, Whelan T, International Patient Decision Aids Standards C (2006) Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. Bmj 333(7565):417. doi:10.1136/bmj.38926.629329.AE PubMedCentralPubMedCrossRef

49.

Visser NJ, Damen TH, Timman R, Hofer SO, Mureau MA (2010) Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction. Plast Reconstr Surg 126(1):26–36. doi:10.1097/PRS.0b013e3181da87a6 PubMedCrossRef

50.

Tadiparthi S, Staley H, Collis N, O’Donoghue JM (2013) An analysis of the motivating and risk factors for conversion from implant-based to total autologous breast reconstruction. Plast Reconstr Surg 132(1):23–33. doi:10.1097/PRS.0b013e318290f83e PubMedCrossRef

51.

Zhong T, Hu J, Bagher S, O’Neill AC, Beber B, Hofer SO, Metcalfe KA (2013) Decision regret following breast reconstruction: the role of self-efficacy and satisfaction with information in the preoperative period. Plast Reconstr Surg 132(5):724e–734e. doi:10.1097/PRS.0b013e3182a3bf5d PubMedCrossRef

52.

Winters ZE, Haviland J, Balta V, Benson J, Reece-Smith A, Betambeau N, Prospective Trial Management G (2013) Integration of patient-reported outcome measures with key clinical outcomes after immediate latissimus dorsi breast reconstruction and adjuvant treatment. British J Surg 100(2):240–251. doi:10.1002/bjs.8959 CrossRef

53.

Gopie JP, Timman R, Hilhorst MT, Hofer SO, Mureau MA, Tibben A (2013) The short-term psychological impact of complications after breast reconstruction. Psycho Oncol 22(2):290–298. doi:10.1002/pon.2089

Title: Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q
Authors: Chunjun Liu
Yan Zhuang
Arash Momeni
Jie Luan
Michael T. Chung
Eric Wright
Gordon K. Lee
Publication date: 01-07-2014
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 1/2014
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-014-2981-z

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