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Implant-based breast reconstruction: aesthetic outcomes, patient reported quality of life and dermal matrix (ADM) use
Eliana F R Duraes, Isis Scomacao; Pauline Vandijck; Vahe Fahradyan; Sagar Rambhia; Andrea Moreira; Risal Djohan; Graham Schwarz; Steven Bernard
Cleveland Clinic
2018-02-15
Presenter: Eliana Duraes
Affidavit:
I certify the project represents original work of the fellow and authors on this project
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: To evaluate factors influencing the outcomes of implant –based breast reconstructions.
Methods: From 2009-2011, patients that underwent implant-based breast reconstructions had their charts retrospectively reviewed, received the post-operative BreastQ, and had their post-operative photos evaluated by a three member panel, blinded to treatment group, using a multi-parameter breast specific scale (scored 1-5). The complication information collected represent the entire reconstruction process and both breasts.
Results: A total of 501 patients (990 breasts) were evaluated. ADM was used in 108(21.5%); 221 had post-operative photos, 144 answered the BreastQ. The group with the higher overall appearance grades (defined by the median 3.66) had scores of 4.19 ± 0.39 vs 2.79 ± 0.45. On this higher aesthetic grade group, patient-reported satisfaction with breasts and Psychological well-being were higher 68.78 ± 19.01 vs 56.81 ± 17.91 (0.005) and 78.00 ± 23.26 vs 68.98 ± 21.05 (p=0.047). The use of the ADM didn't influence the aesthetic outcome: 17(15.7%) on the higher score group vs 25(24.3%) (p=0.121).On a multivariate analysis, the independent factors influencing breast aesthetics were: any major complication (OR 4.71- CI: 1.12–19.80, p=0.027); radiation therapy (OR 8.32 - CI: 1.95 – 35.46, p=0.002), bilaterality (OR 0.210 - CI: 0.057 – 0.768, p=0.010), and mastectomy specimen weight (OR 0.997 – CI: 0.995 – 1.000, p=0.007).
Conclusion: In implant-based breast reconstructions, a good aesthetic outcome is positively influenced by bilateral reconstructions with smaller mastectomy specimens, while major complications and radiation therapy have a deleterious effect. The use of acellular dermal matrix did not influence the overall appearance.
