Objective: Understanding reconstructive outcomes in the breast cancer survivorship period has important implications for patient counseling and shared-medical decision-making. Unfortunately, long-term data on patient-reported satisfaction with breast reconstruction are limited. Expander/implant and autogenous tissue breast reconstructions have different aging processes, and the time when these processes stabilize is unclear. Our goal was to evaluate long-term patient satisfaction with the processes of care, the decision-making process, and final physical appearance between implant and autogenous tissue breast reconstruction.
Methods: A cross-sectional self-administered questionnaire was given to University of Michigan patients who were diagnosed with breast cancer between 1977 and 2006 and had had breast reconstruction (response rate 70%). The sample included post-mastectomy patients with expander/implant (E/I) (N=108) and free and pedicle transverse rectus abdominus flap (TRAM) reconstructions (N=116). Each group was stratified into three post-reconstructive time periods: short-term (£5 years), intermediate (6-8 years), and long-term (>8 years). Validated satisfaction items were scored on a 5-point Likert scale, and scores were dichotomized into positive and negative responses. Chi-square was used for the analyses.
Results: Mean follow-up time after reconstruction was 6.5 years (range 1-18 years). Procedure type had no effect on outcomes in the short-term. However, in the intermediate and long-term, the type of reconstructive procedure considerably impacted patient satisfaction. At 6 to 8 years post-reconstruction, compared to E/I patients, TRAM patients, were significantly more satisfied with the reconstructed breast appearance (p<.01), size (p<.01), shape (p<.03), softness (p<.01) and projection (p<.01). In addition, patients with TRAM, compared to E/I procedures, were significantly more satisfied with their process of reconstruction and had greater decisional satisfaction. TRAM patients felt more strongly that their outcome matched their expectations (p<.01), that they would recommend their type of reconstruction to others (p<.03), that they had a positive experience p (<.03), and that they did not need more surgery to improve the appearance of their breasts (p<.04). TRAM patients also reported greater satisfaction with surgical counseling in regards to postoperative appearance and pain. All of these differences remained significant at > 8 years post-reconstruction.
Conclusions: At greater than 8 years after breast reconstruction, women with TRAM, compared to expander/implant procedures, appear to have significantly greater aesthetic and decisional satisfaction, as well as more satisfaction with the process of reconstruction. These long-term data have important implications for women's health in the cancer survivorship period and will be useful for women navigating the complex decision-making process of breast reconstruction.
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