A Retrospective Analysis of Patient Satisfaction After Immediate Breast Reconstruction

Background: It has only been during the last decade that immediate breast reconstruction (IBR) has become accepted as an integrated part of the treatment for breast cancer. Previously, breast reconstruction was postponed until the breast cancer treatment had been successfully concluded.  IBR is oncologically safe, even in patients with local advanced breast cancer. Several centers still do not perform IBR but it is being proposed and / or used in an increasing number of patients. Patient satisfaction with the final result and (non-oncological) complication rates can be important factors favouring IBR. The aim of this study was to analyze these variables in a population submitted to IBR.

Methods: A retrospective review of patients who underwent immediate reconstruction after breast surgery (conservative surgery and skin sparing mastectomy), was performed from January 2008 to June 2010. The complications were analyzed and the patients reported their level of satisfaction in a 0-10 scale and willingness to undergo the procedure again (Yes or No options).

Results: A total of 55 patients (57 breasts) submitted to IBR were included in this study. Twenty reduction mammaplasties (38,5%) were performed  after conservative breast surgery. After skin sparing mastectomy, patients were submitted to autologous reconstruction with TRAM flap (9 breasts – 16 %), latissimus dorsi flap with implant (10%), tissue expander (23%) and just with a mammary implant (16%). There was a total complication rate of 29,9%, with 1 hematoma and 3 expander/implant infection as major complications (7%). When asking the patients if they would repeat the breast reconstruction, fifty-one (91,2%) said “Yes” and just one said she wouldn’t repeat; one patient couldn’t be contacted. In a 0-10 scale questionnaire of level of satisfaction, the reconstruction with flaps (TRAM and latissimus dorsi flap with implant) had the highest mean value of 9,28; among the prosthetic group (expander and implant) the mean was 8,88 and in reduction mammaplasty the mean value was the lowest,  8,00 . These findings could be related to a lack of knowledge/ comprehension about the reduction mammaplasty like a breast reconstruction technique or high/unrealistic expectations of the patient.

Conclusions:  Immediate breast reconstruction should be integrated in the breast cancer treatment concept as it is associated with a very high patient satisfaction rate and a low major complication rate.