Presentations

Abstract

Introduction: Mastectomy and lumpectomy are common breast cancer treatments, but their impact on self-image can lead many women to opt for breast reconstruction. Breast reconstruction, using artificial implants or the patient's own tissue, aims to preserve breast shape and self-image. Alloplastic reconstruction uses implants, while autologous reconstruction uses the patient's tissue, requiring microvascular reattachment. Most studies on autologous breast reconstruction focus on short-term outcomes or less than 8 years of follow-up, missing much longer-term complications and satisfaction. This retrospective study examines patient satisfaction and outcomes 20-33 years post microvascular free flap breast reconstruction, providing valuable data for physicians and patients to guide their decision-making.

Methods: We reviewed the records of patients who received either unilateral or bilateral free-flap breast reconstruction between July 1990 and December 2003. This provided us with the patient charts and records from which contact info was utilized for requesting consent and completion of the BREAST-Q, a thorough patient-reported outcome measure to gather feedback from patients that is used for evaluating most types of breast surgery including free-flap breast reconstruction in women for determining long term outcomes. (ex: QOL, satisfaction, self-image, (confidence in) sexuality and identity, recurrent surgeries, clothing fit, pain, changes in nipple sensation.) Thus far, 17 patients have completed the BREAST-Q. Currently, chart review of patients to determine other outcomes (tissue necrosis, infection, hematoma, seroma, flap compromise, patient demographics, and abdominal donor site hernia formation) Patients who completed the BREAST-Q were offered a free visit for evaluation by Dr. Colen for further documentation.

Results: Type of reconstruction (scale is 0 to 1; 1 being best) TRAM (n=14) LTP (n=2) LD+TRAM (n=1) Satisfaction with recon breasts 0.94 0.92 0.88 Breast sensation 0.43 0.62 0.33 Psychosocial Well-being 0.92 0.70 0.56 Sexual Well-being 0.70 0.71 0.60 Overall Physical well-being 0.85 0.74 0.70 Physical Well-being Breast 0.93 0.84 0.82 Physical Well-being Abdomen 0.94 1 0.82 Physical Well-being shoulder/back 0.98 0.62 0.46 Satisfaction with healthcare team 0.94 0.8 0.98

Conclusion: Breast sensation is negatively affected by breast reconstruction, including free flap reconstruction, on average ranging from 33% to 55% satisfaction in breast sensation. Patients who received a free-flap breast reconstruction reported an average satisfaction of at least 88% across TRAM, LTP, and LD+TRAM flaps at 20 to 30 years post-surgery. Patients who received TRAM reported an average physical well-being of the abdomen 91%, suggesting TRAM flaps are a good option even when considering the loss of abdominis muscle. Further research is needed to a comparative analysis with long-term outcomes for implant-based reconstructions and a normalized BREAST-Q analysis to understand the impact of autologous and implant based reconstructive breast surgery compared to an appropriate control group.