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

George N. Kamel, David Nash, Joshua Jacobson, Robin Berk, Karan Mehta, Teresa Benacquista, Lawrence B. Draper, Evan S. Garfein, Katie E. Weichman

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)445-451
Number of pages7
JournalJournal of Reconstructive Microsurgery
Volume35
Issue number6
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Mammaplasty
Patient Satisfaction
Quality of Life
Tissue Expansion Devices
Population
Mastectomy
Necrosis
Radiotherapy
Breast
Demography

Keywords

  • delayed breast reconstruction
  • delayed immediate breast reconstruction
  • patient reported satisfaction

ASJC Scopus subject areas

  • Surgery

Cite this

@article{ca12e2849ed74020b8f8bc405f06cdc2,
title = "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",
author = "Kamel, {George N.} and David Nash and Joshua Jacobson and Robin Berk and Karan Mehta and Teresa Benacquista and Draper, {Lawrence B.} and Garfein, {Evan S.} and Weichman, {Katie E.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1055/s-0039-1677798",
language = "English (US)",
volume = "35",
pages = "445--451",
journal = "Journal of Reconstructive Microsurgery",
issn = "0743-684X",
publisher = "Thieme Medical Publishers",
number = "6",

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TY - JOUR

T1 - Patient-Reported Satisfaction and Quality of Life in Postmastectomy Radiated Patients

T2 - A Comparison between Delayed and Delayed Immediate Autologous Breast Reconstruction in a Predominantly Minority Patient Population

AU - Kamel, George N.

AU - Nash, David

AU - Jacobson, Joshua

AU - Berk, Robin

AU - Mehta, Karan

AU - Benacquista, Teresa

AU - Draper, Lawrence B.

AU - Garfein, Evan S.

AU - Weichman, Katie E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - delayed breast reconstruction

KW - delayed immediate breast reconstruction

KW - patient reported satisfaction

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DO - 10.1055/s-0039-1677798

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