Plastic Surgery Research Council
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Presenter: Rika Ohkuma, MD
Co-Authors: Lacayo Baez M; Rad AN; Manahan MA; Sacks JM; Cooney DS; Cooney CM; Rosson GD
Johns Hopkins Medical Institution

Purpose: Breast reconstruction following mastectomy has been shown to improve quality of life (QoL) scores in studied patients. The goal of this study was to quantify and compare QoL scores for breast cancer patients undergoing different surgical procedures.

Methods: We performed an IRB-approved prospective study of patients undergoing breast reconstruction at the Johns Hopkins Hospital. Two validated questionnaires, the RAND-36 and BREAST-Q, were administered at three time points: preoperatively, prior to any additional major reconstruction surgeries (in staged cases), and at 6-month post-reconstruction. Comparisons between pre- and post-operative questionnaire responses were made between patients who underwent autologous vs. implant reconstruction and immediate vs. staged reconstruction. Responses were analyzed using the paired t-test.

Results: Between November 2010 and August 2012, 113 female patients [mean age: 50.42 +/- 9.78 (range 21-74)] were enrolled and completed their major reconstructive surgery including 41 patients with at least 6-month follow-up survey.When comparing pre-operative and 6-month post-operative QoL scores, patients in non-staged reconstruction and autologous flap reconstruction groups showed significantly higher scores in satisfaction with breasts and psychosocial well-being, despite lower satisfaction with abdomen.After tissue expander (TE) reconstruction, patients were found to have lower BREAST-Q scores for satisfaction with breasts, chests and sexual well-being, but higher RAND 36 scores for physical functioning and role limitations due to physical health despite the pain, comparing to pre-operative scores.

Conclusion: Patients' QoL is significantly improved following reconstruction with a positive psychological impact on patients physical well-being. Reconstruction using autologous tissue flap or performed in a non-staged manner provide better 6-month post-operative satisfaction. The role of QoL is an important concept when counseling patients regarding potential treatment pathway and planning breast reconstruction for patients choosing among options.

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