Patient Reported Satisfaction and Quality of Life in the First Year Following Immediate Breast Reconstruction: A Comparison of Microsurgical and Implant-Based Procedures in a Minority Population

Purpose: Autologous breast reconstruction after mastectomy has been shown to result in higher patient satisfaction persisting from short- to long-term. However, this finding has been demonstrated primarily in non-minority women. The aim of this study was to evaluate short-term patient-reported outcomes in women undergoing implant-based and microsurgical reconstruction in a largely minority population. 

Methods: Women undergoing immediate breast reconstruction after mastectomy were enrolled at Montefiore Medical Center between June 2015 and September 2017. Patients completing preoperative and one year postoperative BREAST-Q surveys were included for analysis and divided into two groups of breast reconstruction: implant-based and microsurgical (flap). The outcome measures of interest were BREAST-Q (Reconstruction Module) scores for psychosocial well-being, abdominal physical well-being, chest physical well-being, sexual well-being, satisfaction with breasts, and satisfaction with overall outcome. Survey scores were compared between groups using t-tests or Mann-Whitney tests after assessing for normality of score distribution.

Results: Seventy-five women were included for analysis (implant-based n=40 (52.3%), flap n=35 (46.7%)). Mean body mass index, race/ethnicity (overall 87% Black or Hispanic), education, income, procedure laterality, and mastectomy weight did not differ between groups. Reconstructive timing differed between groups (implant-based 100% immediate, flap 43% immediate 57% delayed-immediate; p<0.001). Median survey follow-up time was 11.8 (IQR 5.8-13) months from the date of first reconstructive procedure. Women undergoing microsurgical reconstruction had higher median postoperative satisfaction with breasts (implant-based=55 [IQR 38-62], flap=58 [IQR 54-67]; p=0.02) and greater mean difference in satisfaction with breasts between postoperative and preoperative scores (implant-based=-11±27, flaps=+11±26; p<0.001), despite a higher median preoperative satisfaction with breasts in the implant-based group (implant-based 58 [IQR 48-70], flap 43 [IQR 33-63]; p=0.04). Median postoperative psychosocial well-being, abdominal physical well-being, chest physical well-being, sexual well-being, and satisfaction with overall outcome did not differ between groups.

Conclusions: Patients undergoing microsurgical breast reconstruction have superior patient-reported outcomes at one year compared to those with implant-based reconstruction. Additionally, patients undergoing microsurgical reconstruction display improved satisfaction with breasts postoperatively as compared to the preoperative state.