J reconstr Microsurg 2019; 35(06): 445-451
DOI: 10.1055/s-0039-1677798
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
David Nash
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Joshua Jacobson
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Robin Berk
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Karan Mehta
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Teresa Benacquista
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Lawrence B. Draper
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Evan S. Garfein
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Katie E. Weichman
1  Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
› Author Affiliations
Further Information

Publication History

30 August 2018

09 December 2018

Publication Date:
04 February 2019 (eFirst)

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.

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.