Patient-Reported Satisfaction and Quality of Life Following Post-Mastectomy Pedicled and Free Abdominal Flap Reconstruction: Is There a Difference?

Purpose: In 2012, 12,533 abdominal flap breast reconstructions were performed in the USA, 63.8% of all autologous breast reconstructions performed.¹The purpose of this study was to compare patient-reported satisfaction and quality of life between pedicled and free abdominal flap reconstruction using the BREAST-Q.

Methods:  Women undergoing post-mastectomy breast reconstruction using pedicled or free abdominal flaps were identified from two prospectively maintained databases at two sites in North America from 2008-2013, and were asked to complete the BREAST-Q post-operatively. BREAST-Q scores were assessed for each domain and compared between pedicled and free abdominal flap patients, with higher scores indicating greater satisfaction/outcome.

Results:  Of the 171 patients who completed the BREAST-Q, 96 (56.1%) underwent pedicled flap reconstruction and 75 (43.9%) underwent free flap reconstruction. Pedicled patients were older (mean 54.1 years v 51.1, p=0.020), had longer length of time from reconstruction to BREAST-Q completion (mean 47.5 months v 35.9, p=0.000), and were more likely to have unilateral (87.5% v 72.0%, p=0.011) and immediate reconstruction (79.2% v 64.0%, p=0.044). Overall, patients who underwent pedicled flap reconstruction scored significantly higher on the BREAST-Q compared to free flap reconstruction patients in Satisfaction with Breasts (+5.9, p=0.043), Sexual Well-Being (+7.5, p=0.045), and Physical Well-Being Chest (+5.6, p=0.022). There was no significant difference in the Physical Well-Being Abdomen (+3.0, p=0.394) or Satisfaction with Outcome (+2.6, p=0.450) scores. However, when post-operative follow-up time was controlled for to include only patients at ≥36 months post-op  (mean 57.8 months for pedicled (N=68 patients) v 56.3 months for free (N=34 patients), p=0.544), there were no significant differences in BREAST-Q scores, including Satisfaction with Breasts (+3.1, p=0.474), Outcome (-2.5, p=0.547), Sexual Well-Being (+0.3, p=0.955), Chest (+3.3, p=0.292), and Abdomen (-1.5, p=0.764).

Conclusions: Decision-making in breast reconstruction can be difficult as patients are often offered many options, including pedicled and free abdominal flap reconstruction. In this study, patients who underwent pedicled flap reconstruction had greater initial satisfaction compared to those who underwent free flap reconstruction. However, when post-operative time was controlled for, there were no significant differences between the two. Thus, patients may be equally satisfied with either reconstruction, or rather patient satisfaction equalizes between the two over time. These results can be used to facilitate clinical and patient decision-making in the setting of autologous breast reconstruction.