Autologous Breast Reconstruction after Failed Implant-Based Reconstruction: Evaluation of Surgical and Patient-Reported Outcomes and Quality of Life

Plastic and Reconstructive Surgery - Tập 143 Số 2 - Trang 373-379 - 2019
Michelle Coriddi1, Deana Shenaq1, Elizabeth Kenworthy1, Jacques Mbabuike1, Jonas A. Nelson1, Andrea L. Pusic1, Babak J. Mehrara1, Joseph J. Disa1
1From the Department of Surgery, Plastic and Reconstructive Surgery Section, Memorial Sloan Kettering Cancer Center.

Tóm tắt

Background:

There is a subset of patients who initially undergo implant-based breast reconstruction but later change to autologous reconstruction after failure of the implant reconstruction. The purpose of this study was to examine outcomes and quality of life in this group of patients.

 Methods:

After institutional review board approval, a retrospective chart review of a prospectively maintained database was performed and BREAST-Q surveys were evaluated.

 Results:

One hundred thirty-seven patients underwent autologous breast reconstruction following failed implant-based reconstruction with 192 total flaps. Failure of implant reconstruction was defined as follows: capsular contracture causing pain and/or cosmetic deformity [n = 106 (77 percent)], dissatisfaction with the aesthetic result [n = 15 (11 percent)], impending exposure of the implant/infection [n = 8 (6 percent)], and unknown [n = 8 (6 percent)]. Complications requiring operative intervention included partial flap loss [n = 5 (3 percent)], hematoma [n = 5 (3 percent)], vascular compromise requiring intervention for salvage [n = 2 (1 percent)], and total flap loss [n = 1 (1 percent)]. Thirty-four patients (23 percent) had BREAST-Q surveys. There was a statistically significant increase in overall outcomes (p < 0.001), satisfaction with appearance of breasts (p < 0.001), psychosocial well-being (p < 0.001), and physical well-being of the chest (p = 0.003). A statistically significant decrease in physical well-being of the abdomen was observed (p = 0.001).

 Conclusions:

Autologous breast reconstruction after failed implant-based reconstruction has an acceptable complication rate and is associated with significantly improved patient satisfaction and quality of life.

 CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.

Từ khóa


Tài liệu tham khảo

Pusic, 2017, Patient-reported outcomes 1 year after immediate breast reconstruction: Results of the mastectomy reconstruction outcomes consortium study., J Clin Oncol, 35, 2499, 10.1200/JCO.2016.69.9561

Eltahir, 2015, Which breast is the best? Successful autologous or alloplastic breast reconstruction: Patient-reported quality-of-life outcomes., Plast Reconstr Surg, 135, 43, 10.1097/PRS.0000000000000804

Pirro, 2017, Comparison of patient-reported outcomes after implant versus autologous tissue breast reconstruction using the BREAST-Q., Plast Reconstr Surg Glob Open, 5, e1217, 10.1097/GOX.0000000000001217

Sgarzani, 2015, Patient satisfaction and quality of life in DIEAP flap versus implant breast reconstruction., Surg Res Pract, 2015, 405163

Weichman, 2015, Patient-reported satisfaction and quality of life following breast reconstruction in thin patients: A comparison between microsurgical and prosthetic implant recipients., Plast Reconstr Surg, 136, 213, 10.1097/PRS.0000000000001418

Alderman, 2000, Determinants of patient satisfaction in postmastectomy breast reconstruction., Plast Reconstr Surg, 106, 769, 10.1097/00006534-200009020-00003

Aguiar, 2017, Patient-reported outcomes measured by BREAST-Q after implant-based breast reconstruction: A cross-sectional controlled study in Brazilian patients., Breast, 31, 22, 10.1016/j.breast.2016.10.008

Visser, 2010, Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction., Plast Reconstr Surg, 126, 26, 10.1097/PRS.0b013e3181da87a6

Feng, 1994, Autogenous tissue breast reconstruction in the silicone-intolerant patient., Cancer, 74, 440, 10.1002/cncr.2820741333

Rojas, 2018, Body mass index (BMI), postoperative appearance satisfaction, and sexual function in breast cancer survivorship., J Cancer Surviv, 12, 127, 10.1007/s11764-017-0651-y

Albornoz, 2014, Implant breast reconstruction and radiation: A multicenter analysis of long-term health-related quality of life and satisfaction., Ann Surg Oncol, 21, 2159, 10.1245/s10434-014-3483-2

Nelson, 2017, Breast reconstruction and radiation therapy: An update., Plast Reconstr Surg, 140, 60S, 10.1097/PRS.0000000000003943

Momoh, 2017, Tradeoffs associated with contralateral prophylactic mastectomy in women choosing breast reconstruction: Results of a prospective multicenter cohort., Ann Surg, 266, 158, 10.1097/SLA.0000000000001840

Sisco, 2015, The quality-of-life benefits of breast reconstruction do not diminish with age., J Surg Oncol, 111, 663, 10.1002/jso.23864

Cordeiro, 2015, What is the optimum timing of postmastectomy radiotherapy in two-stage prosthetic reconstruction: Radiation to the tissue expander or permanent implant?, Plast Reconstr Surg, 135, 1509, 10.1097/PRS.0000000000001278

Ricci, 2017, A meta-analysis of implant-based breast reconstruction and timing of adjuvant radiation therapy., J Surg Res, 218, 108, 10.1016/j.jss.2017.05.072

Largo, 2018, Outcome analysis of free flap salvage in outpatients presenting with microvascular compromise., Plast Reconstr Surg, 141, 20e, 10.1097/PRS.0000000000003917

Hu, 2009, Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period., Plast Reconstr Surg, 124, 1, 10.1097/PRS.0b013e3181ab10b2

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Thông tin xuất bản

Plastic and Reconstructive Surgery

Tập 143 Số 2

373-379

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