Introduction: Immediate breast reconstruction (IBR) is offered to suitable patients who require mastectomy for cancer treatment. There are few studies that directly address patient perception in the same study cohort. We present the results of a consecutive series of patients who had a submuscular implant reconstruction alone or an implant assisted latissimus flap.

Objective: The aim of this study was to establish differences in patient perception on IBR soon after completion of oncologic management and five years later. Standardised surgery was performed under the care of a single consultant surgeon and a uniform implant device was used, McGhan 150 biodimensional anatomical permanent expander implant.

Patients & Method: 40 patients undergoing mastectomy for early breast cancer were prospectively studied at one year and six years post surgery. The mean patient age at cancer diagnosis was 46 (20-76) years. A validated modification of the QLQBR-23 breast cancer outcomes questionnaire was used to measure body image perception, physical effects, cancer worry and surgical choice. The data were analysed using Spearman rank correlation and the Stuart-Maxwell test of marginal homogeneity.

Results: Patients' satisfactions were similar after the 1st and 6th years when perception of attractiveness, femininity, difficulty being seen nude by partner and the effect of surgery on feeling less whole were considered. The majority of the responses reported highly favourable outcomes. However, whilst women were generally satisfied with the appearances of their breasts overall, there was a greater proportion of dissatisfaction at six years compared to one year (p=0.009). The proportion of women who would have chosen a different surgical strategy increased from 18 to 28% but this difference was not statistically significant (p=0.099). Cancer worry was unaffected with longer follow-up.

Conclusion: Whilst there was deterioration in patients' satisfaction with implant based IBR over time, the majority of patients remained happy with their treatment decision and outcome.
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