Patient-Reported Outcomes in Implant-Based Breast Reconstruction Alone or in Combination with a Titanium-Coated Polypropylene Mesh – A Detailed Analysis of the BREAST-Q and Overview of the Literature

Abstract

Background: Complication rates and surgical outcomes are well reported for implant-based breast reconstruction (IBBR) using supportive materials for the inferior pole of the breast. Patient-reported outcomes (PRO) are underrepresented. The aim of this study was to compare PRO in IBBR using implants alone or in combination with a synthetic mesh. Methods and Methods: PRO was measured in patients undergoing IBBR alone or in combination with a titanium-covered polypropylene mesh (TiLOOP® Bra). In this non-randomized observational trial PRO was retrospectively assessed using the validated self-reporting BREAST-Q. The raw responses of all questions applied in each domain and transformed BREAST-Q data using the Q-Score are presented. Results: Of 90 eligible women, 42 received IBBR alone and 48 received IBBR in combination with mesh. No differences in complication rates were observed. The return rate was 67.7 % and was comparable between the groups (p = 0.117). PRO revealed no differences regarding satisfaction with breast shape (p = 0.079), outcome (p = 0.604), nipple sensitivity (p = 0.502), preoperative information (p = 0.195), office staff (p = 0.462), psychosocial well-being (p = 0.370), sexual well-being (p = 0.508) and physical well-being (p = 0.654). Significant differences were noted regarding satisfaction with the surgeon (p = 0.013) and medical staff (p = 0.035) as well as the response behavior of certain questions of the sub-domains, thus helping to further stratify PRO with regards to aesthetic outcome. However, no differences were observed in the main BREAST-Q results. Conclusion: Use of the TiLOOP® Bra in IBBR results in comparable BREAST-Q scores compared with IBBR alone. Evaluating the BREAST-Q sub-domains helps to stratify PRO more profoundly and assists in interpreting the overall results and specific research questions.

Zusammenfassung

Hintergrund: Studien zur Patienteneinschätzung und Zufriedenheit (Patient-Reported Outcomes [PRO]) sind im Rahmen der implantatgestützten Brustrekonstruktion (BR) mit Materialien zur Stabilisierung des unteren Brustpols unterrepräsentiert. Ziel dieser Arbeit war der Vergleich von PRO in der implantatgestützten BR mit oder ohne Anwendung eines synthetischen Netzes. Material und Methoden: PRO wurde bei Patientinnen mit implantatgestützten BR alleine oder in Kombination mit einem titanbeschichteten Polypropylene-Netz (TiLOOP® Bra) untersucht. Mithilfe des selbstberichtenden BREAST-Q-Fragebogens wurde in dieser nicht randomisierten Beobachtungsstudie PRO restrospektiv ausgewertet. Rohscores aller Fragen der einzelnen Subdomains und die mit dem Q-Score transformierten BREAST-Q-Daten werden präsentiert. Ergebnisse: Von 90 Patientinnen erhielten 42 eine BR mit Implantaten alleine und 48 eine Implantatrekonstruktion mit Netz. Kein Unterschied in der Komplikationsrate wurde beobachtet. Die Rücklaufquote des Fragebogens lag bei 67,7 % und war zwischen den Gruppen vergleichbar (p = 0,117). PRO zeigte keine Unterschiede bez. Brustform (p = 0,079), Ergebnis (p = 0,604), Sensitivität des Nippels (p = 0,502), präoperativer Aufklärung (p = 0,195), Praxispersonal (p = 0,462), psychosozialer Zufriedenheit (p = 0,370), sexueller Zufriedenheit (p = 0,508) und physischer Zufriedenheit (p = 0,654). Signifikante Unterschiede zeigen sich bei Zufriedenheit mit Operateur (p = 0,013), medizinischem Personal (p = 0,035) sowie im Antwortverhalten bestimmter Fragen der Subdomains hilfreich, um PRO im Hinblick auf das ästhetische Ergebnis weiter zu stratifizieren. Zusammenfassung: Die Verwendung von TiLOOP® Bra in der implantatgestützten BR resultiert in vergleichbaren BREAST-Q Ergebnissen im Vergleich zur BR mit Implantaten allein. Die Untersuchung der Subdomains hilft, PRO weiter zu stratifizieren, und ist nützlich in der Interpretation der Gesamtergebnisse und spezifischer Forschungsfragen.

Key words

breast reconstruction - mesh - quality of life - TiLOOP® Bra - BREAST-Q - patient-reported outcome

Schlüsselwörter

Brustrekonstruktion - Netz - Lebensqualität - TiLOOP® Bra - BREAST-Q - Patientenzufriedenheit

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