Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction

A prospective analysis of early postoperative outcomes

Authors

  • Toni Zhong MD,

    Corresponding author
    1. Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
    • Division of Plastic and Reconstructive Surgery, University Health Network, 8N 871, 200 Elizabeth Street, Toronto, ON, Canada
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    • Fax: (416) 340-4403

  • Colleen McCarthy MD,

    1. Plastic and Reconstructive Surgical Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Sandar Min MD,

    1. Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Jing Zhang MD,

    1. Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
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  • Brett Beber MD,

    1. Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
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  • Andrea L. Pusic MD,

    1. Plastic and Reconstructive Surgical Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Stefan O. P. Hofer MD

    1. Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abstract

BACKGROUND:

For this study, the authors evaluated early psychosocial adjustments and health-related quality-of-life changes after breast reconstruction.

METHODS:

All consecutive patients who underwent breast reconstruction between June 2009 and November 2010 were asked to complete the BREAST-Q, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale (IES) questionnaires before surgery and at 3 weeks and 3 months after surgery. A repeated-measures design was used to compare scores between baseline and postoperative time points.

RESULTS:

Fifty-one of 55 women completed the questionnaires (response rate, 93%). BREAST-Q subscale scores (breast, sexual well being, and psychosocial well being) improved significantly (P < .05) postoperatively. The other subscale scores related to physical well being of the chest and abdomen dropped significantly 3 weeks after reconstruction; and, by 3 months after reconstruction, both scores improved significantly (P < .05). Large effect sizes for improvements in satisfaction, psychosocial well being, and sexual well being were observed (1.88, 1.2, and 1.31, respectively); whereas deterioration in the effect size for abdominal donor site was reported (−1.56). After adjusting for postoperative complications, there were statistically significant changes in BREAST-Q subscale scores. Changes observed on the HADS and IES provided external validation of the findings obtained on the BREAST-Q.

CONCLUSIONS:

The current results suggested that the gains in breast satisfaction, psychosocial well being, and sexual well being after patients undergo either free muscle-sparing transverse rectus abdominis myocutaneous flap reconstruction or deep inferior epigastric artery flap reconstruction are statistically significant and clinically meaningful to the patient as early as 3 weeks after surgery. However, these gains are accompanied by significant deterioration in physical well being of the abdominal donor site. Cancer 2011;. © 2011 American Cancer Society.

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