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Aesthetic Outcome and Satisfaction with Breasts after Breast Reconstruction: correlating patient and physician perspectives.
Eliana F.R. Duraes, Todd Baker, Megan Morisada, Susan Orra, Mona Ascha, Joao Batista de Sousa, Risal S. Djohan, Steven Bernard, Graham S. Schwarz, Andrea Moreira
Cleveland Clinic Foundation
2016-02-15
Presenter: Eliana F.R. Duraes
Affidavit:
Eliana Duraes participated in all steps of this study.
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
According to the American Society of Plastic Surgeons, in 2014 more than 102,200 breast reconstruction surgeries were performed. This study aims to establish factors influencing aesthetic outcomes and patient reported satisfaction with breasts after breast reconstruction.
Patients who started any type of breast reconstruction from 2009-2011 received post-operative breast related quality of life questionnaires – BreastQ1. Post-operative photos from patients that answered the questionnaire were graded by a six-member blinded panel using a multi-parameter breast specific scale (scored 1-5). The satisfaction with breasts reported by the patients using the questionnaires was compared with the overall outcome graded by the panel.
261 of 820 patients answered the questionnaires. Median length of follow-up, before the questionnaire, was 48 (38-60) months. Satisfaction with breasts was higher in autologous reconstruction (ABR)(p<0.05), bilateral reconstructions (BiR)(p<0.01), and patients with body mass index(BMI) 25-29.9 versus >30 (p<0.05). 147 patients had their post-operative photos graded. Superior aesthetic outcomes were observed for ABR vs implant-based reconstructions (p<0.01), no-radiationtherapy(RT) vs RT, and BiR vs unilateral. Breast and nipple symmetry were significantly better on BiR (p<0.01). There was a correlation between the aesthetic outcome and patient satisfaction with breasts (r=0.32, p<0.001).
Patient satisfaction with breasts and aesthetic outcomes are highest with ABR, BiR and without RT. Presence of lower BMI and nipple reconstruction positively influence satisfaction. Breast and nipple symmetry are superior in BiR. Although there was a correlation between the aesthetic outcome graded and the patient reported satisfaction with breasts, an aesthetically pleasant breast does not guarantee patient satisfaction.
