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Aesthetics and Patient Reported Outcomes Following Microsurgical Breast Reconstruction after Nipple Sparing Mastectomy
Eliana Duraes MD, Todd Baker MD, Megan Morisada BS, Paul Durand MD, Steven Rueda MD, Risal Djohan MD, Andrea Moreira MD, Steven Bernard MD, Joao Batista de Sousa MD PhD, Graham Schwarz MD.
Cleveland Clinic - Plastic Surgery Department
2015-03-12
Presenter: Eliana Duraes
Affidavit:
Most of the work was done by the presenting author
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Autologous breast reconstruction often results in more natural and durable results and has been associated with higher long-term patient satisfaction. We hypothesized that combining free flap breast reconstruction with nipple-sparing mastectomy (NSM) would result in optimal aesthetics and breast reconstruction related quality of life (QOL). The aim of this study was to quantitatively assess these outcomes.
Patients who underwent microsurgical breast reconstruction after NSM between 2007 and 2014 were included. BreastQ post-operative questionnaires were administered to assess QOL. Blinded grading of aesthetic outcomes was performed by a professional panel using a novel breast reconstruction aesthetic scale.
A total of 45 breasts in 29 patients were reconstructed. Fourteen patients answered the questionnaire. Twenty-two patients underwent aesthetic outcome grading. The mean overall appearance graded by medical professionals using post-operative photos (3.71±0.62) demonstrated a direct correlation with patient satisfaction with breasts (73.42±19.68) (Pearson's R=0.918). Mean patient satisfaction with nipples was 84.36±24.45, and mean grade for overall nipple appearance by medical professionals was 4.0±0.57. There was no correlation between patient satisfaction with the reconstructive outcome and the mean grading of overall breast appearance by medical professionals (Pearson's R=-0.225).
NSM followed by abdominally based microsurgical breast reconstruction achieved excellent patient-reported QOL. Patient satisfaction with nipples was superior to that reported for non-NSM autologous reconstruction. Very good aesthetic outcomes were achieved as graded by medical professionals, with excellent grades for nipple-related parameters. Patient satisfaction with breasts and medical professional perception of breast aesthetics directly correlate. Nipple preservation contributes to breast related QOL following microsurgical breast reconstruction.
