Patient-Reported Outcomes in Free-Flap Breast Reconstructive Surgery over Time (PRO-BREST)

Duveken B Y Fontein; Melanie Oros; Leonhard Held; Pietro Giovanoli; Andrea L Pusic; Nicole Lindenblatt

doi:10.1159/000519804

Patient-Reported Outcomes in Free-Flap Breast Reconstructive Surgery over Time (PRO-BREST)

Breast Care (Basel). 2022 Jun;17(3):272-278. doi: 10.1159/000519804. Epub 2021 Dec 1.

Authors

Duveken B Y Fontein¹, Melanie Oros¹, Leonhard Held², Pietro Giovanoli¹, Andrea L Pusic³, Nicole Lindenblatt¹

Affiliations

¹ Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
² Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
³ Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Abstract

Introduction: Patient-reported outcomes (PROMs) are increasingly relevant to assess surgical quality and guide decisions in breast reconstruction (BR). Satisfaction with outcomes may change as time progresses. We assessed satisfaction in patients who underwent free-flap BR in the last 12 years.

Methods: All patients who underwent free-flap BR from 2006 to 2018 were invited to complete the validated BREAST-Q for reconstruction. The BREAST-Q comprises 6 domains covering various aspects of satisfaction. Unadjusted linear regression assessed the relationship between different domains of the BREAST-Q and time since BR. Two-sample t tests assessed differences in satisfaction between patients who underwent BR ≥5 years versus <5 years prior.

Results: Forty-three women with primary or secondary free-flap BR between 2006 and 2018 were included in the study. Most patients (n = 33, 76.7%) underwent DIEP flap BR. Overall satisfaction with breasts and with outcomes improved as time since BR increased (p = 0.031 and p = 0.017, respectively). Overall satisfaction with outcomes scored higher in patients with BR ≥5 years prior (≥5 years vs. <5 years: breast score 88.6 (SD 12.5) versus 66.9 (SD 21.8); p = 0.005). Satisfaction with breasts and psychosocial well-being also scored higher in these patients. There was no difference in results between primary and secondary BR. Patients who underwent additional surgery (refinements) reported higher satisfaction with outcomes and abdominal well-being.

Conclusions: PROMs concerning satisfaction with breast and with outcomes following BR improve as time since treatment progresses. This study demonstrates that time since diagnosis may be an important factor in satisfaction. It underlines the importance of long-term PROMs related to BR, to help provide patients and health care professionals in decision-making and in managing expectations related to BR.

Keywords: Breast cancer; Breast reconstruction; Coping; Patient-reported outcome measure; Quality of life.