Patient-Reported Satisfaction and Quality of Life in Postmastectomy Radiated Patients: A Comparison between Delayed and Delayed Immediate Autologous Breast Reconstruction in a Predominantly Minority Patient Population

Abstract

Background Delayed immediate (DI) autologous breast reconstruction consists of immediate postmastectomy tissue expander placement, radiation therapy, and subsequent autologous reconstruction. The decision between timing of reconstructive methods is challenging and remains to be elucidated. We aim to compare patient reported outcomes and quality of life between delayed and DI reconstruction.

Methods A retrospective review of all patients, who underwent autologous breast reconstruction at Montefiore Medical Center from January 2009 to December 2016, was conducted. Patients who underwent postmastectomy radiotherapy were divided into two cohorts: delayed and DI autologous breast reconstruction. Patients were mailed a BREAST-Q survey and their responses, demographic information, complications, and need for revisionary procedures were analyzed.

Results A total of 79 patients met inclusion criteria: 34.2% (n = 27) in the delayed and 65.8% (n = 52) in the DI group. 77.2% (n = 61) of patients were a minority population. Patients in each cohort had similar baseline characteristics; however, the DI cohort was more likely to have bilateral reconstruction (46.2% [n = 24] vs. 7.4% [n = 2]; p = 0.0005) and to have major mastectomy flap necrosis (22.4% [n = 17] vs. 0.0% [n = 0]; p = 0.002). Premature tissue expander removal occurred in 17.3% (n = 9) of patients in the DI group. BREAST-Q response rates were 44.4% (n = 12) in the delayed group and 57.7% (n = 30) in the DI group. Responses showed similar satisfaction with their breasts, well-being, and overall outcome.

Conclusion Delayed and DI autologous breast reconstruction yield similar patient-reported satisfaction; however, patients undergoing DI reconstruction have higher rates of major mastectomy necrosis. Furthermore, patients in the DI group risk premature tissue expander removal.

Keywords

delayed breast reconstruction - delayed immediate breast reconstruction - patient reported satisfaction

Note

This study was presented at Northeastern Society of Plastic Surgeons (NESPS) 2017 in Newport, Rhode Island, American Society of Reconstructive Microsurgery (ASRM) 2018 in Phoenix, Arizona, and Plastic Surgery Research Council (PSRC) 2018 in Birmingham, Alabama.

Financial Disclosure

Dr. E.S.G. is founder of SigmaSurgical, limited liability corporation (LLC) and a consultant for Stryker Corp.

• References

• 1 Kronowitz SJ, Hunt KK, Kuerer HM. , et al. Delayed-immediate breast reconstruction. Plast Reconstr Surg 2004; 113 (06) 1617-1628
• 2 Kronowitz SJ, Lam C, Terefe W. , et al. A multidisciplinary protocol for planned skin-preserving delayed breast reconstruction for patients with locally advanced breast cancer requiring postmastectomy radiation therapy: 3-year follow-up. Plast Reconstr Surg 2011; 127 (06) 2154-2166
• 3 Patel KM, Albino F, Fan KL, Liao E, Nahabedian MY. Microvascular autologous breast reconstruction in the context of radiation therapy: comparing two reconstructive algorithms. Plast Reconstr Surg 2013; 132 (02) 251-257
• 4 Shechter S, Arad E, Inbal A, Friedman O, Gur E, Barnea Y. DIEP flap breast reconstruction complication rate in previously irradiated internal mammary nodes. J Reconstr Microsurg 2018; 34 (06) 399-403
• 5 Mull AB, Qureshi AA, Zubovic E. , et al. Impact of time interval between radiation and free autologous breast reconstruction. J Reconstr Microsurg 2017; 33 (02) 130-136
• 6 Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1983; 1 (8322): 459-462
• 7 Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 2000; 92 (17) 1422-1429
• 8 Taylor ME, Haffty BG, Rabinovitch R. , et al. ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast. Int J Radiat Oncol Biol Phys 2009; 73 (04) 997-1002
• 9 Nelson JA, Disa JJ. Breast reconstruction and radiation therapy: an update. Plast Reconstr Surg 2017; 140 (5S, Advances in Breast Reconstruction): 60S-68S
• 10 Albino FP, Patel KM, Smith JR, Nahabedian MY. Delayed versus delayed-immediate autologous breast reconstruction: a blinded evaluation of aesthetic outcomes. Arch Plast Surg 2014; 41 (03) 264-270
• 11 Kronowitz SJ. Current status of autologous tissue-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 2012; 130 (02) 282-292
• 12 Lam TC, Hsieh F, Salinas J, Boyages J. Two-stage prosthetic breast reconstruction after mastectomy with or without prior postmastectomy radiotherapy. Plast Reconstr Surg Glob Open 2017; 5 (09) e1489
• 13 Cano SJ, Klassen A, Pusic AL. The science behind quality-of-life measurement: a primer for plastic surgeons. Plast Reconstr Surg 2009; 123 (03) 98e-106e
• 14 Curtin CM, Chung KC. A reflection of outcomes research and its impact on the practice of hand surgery. J Hand Surg Eur Vol 2014; 39 (07) 790-793
• 15 Pusic AL, Chen CM, Cano S. , et al. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg 2007; 120 (04) 823-837 , discussion 838–839
• 16 Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124 (02) 345-353
• 17 Cohen WA, Mundy LR, Ballard TN. , et al. The BREAST-Q in surgical research: A review of the literature 2009-2015. J Plast Reconstr Aesthet Surg 2016; 69 (02) 149-162
• 18 Craft RO, Colakoglu S, Curtis MS. , et al. Patient satisfaction in unilateral and bilateral breast reconstruction [outcomes article]. Plast Reconstr Surg 2011; 127 (04) 1417-1424
• 19 Kronowitz SJ. Delayed-immediate breast reconstruction: technical and timing considerations. Plast Reconstr Surg 2010; 125 (02) 463-474
• 20 Ho AL, Tyldesley S, Macadam SA, Lennox PA. Skin-sparing mastectomy and immediate autologous breast reconstruction in locally advanced breast cancer patients: a UBC perspective. Ann Surg Oncol 2012; 19 (03) 892-900
• 21 Zinzindohoué C, Bertrand P, Michel A. , et al. A prospective study on skin-sparing mastectomy for immediate breast reconstruction with latissimus dorsi flap after neoadjuvant chemotherapy and radiotherapy in invasive breast carcinoma. Ann Surg Oncol 2016; 23 (07) 2350-2356
• 22 Hughes K, Neoh D. Neoadjuvant radiotherapy: changing the treatment sequence to allow immediate free autologous breast reconstruction. J Reconstr Microsurg 2018; 34 (08) 624-631
• 23 Monrigal E, Dauplat J, Gimbergues P. , et al. Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study. Eur J Surg Oncol 2011; 37 (10) 864-870
• 24 Soni SE, Lee MC, Gwede CK. Disparities in use and access to postmastectomy breast reconstruction among African American women: a targeted review of the literature. Cancer Contr 2017; 24 (04) 1073274817729053
• 25 Rodby KA, Danielson KK, Shay E, Robinson E, Benjamin M, Antony AK. Trends in breast reconstruction by ethnicity: an institutional review centered on the treatment of an urban population. Am Surg 2016; 82 (06) 497-504