Health-Related Quality of Life Throughout the Breast ReconstructionProcess: A Prospective Cohort of 300 Patients with Long-Term Follow-Up
Gedge D. Rosson, MD1, Michael A. Cheah, MD2, Ricardo J. Bello, MD, MPH1, Mohamad E. Sebai, MBBS1, Jeff Aston, BS1, Eric L. Wan, BS1, Charalampos Siotos, MD1, Michele A. Manahan, MD1, Justin M. Sacks, MD, MBA1, Carisa M. Cooney, MPH1.
1Johns Hopkins University School of Medicine, Department of Plastic Surgery, Baltimore, MD, USA, 2Inova Fairfax Medical Campus, Department of Surgery, Falls Church, VA, USA.
Background: With rising breast reconstruction rates, questions remain on the impact of shifting modalities of reconstruction and concurrent treatments on quality-of-life (QoL). This study aimed to track QoL in breast reconstruction patients according to reconstructive modality and PMRT.
Methods: We prospectively followed patients undergoing breast reconstruction from 2010-2015 using BreastQ© and RAND-36 preoperatively, after tissue expander placement, and 6 and 12 months after final reconstruction. We used Wilcoxon signed-rank test, ANOVA, and multiple linear regression to estimate associations between QoL, reconstruction type and timing, and post-mastectomy radiotherapy (PMRT).
Results: Of 300 patients followed, 124 underwent implant-based, 151 autologous, 10 mixed implant and autologous, and 15 pure fat grafting reconstructions. Forty-four were immediate, 202 staged, and 54 delayed. Seventy-seven patients received PMRT. Postoperatively, QoL increased for Satisfaction with Breasts, Psychosocial Wellbeing, and RAND36 Summary Mental Health (p<0.01), whereas Physical Wellbeing of Abdomen decreased in autologous reconstruction patients (p<0.001). Autologous reconstruction was associated with higher Satisfaction with Breasts (p<0.001) and trended toward higher Psychosocial Wellbeing (p=0.095) and RAND36 Physical Health Summary Score (p=0.074). Delayed reconstruction was associated with higher Satisfaction with Breasts (p=0.003), Psychosocial Wellbeing (p=0.044), and Sexual Wellbeing (p=0.018). After adjusting for confounding, PMRT was associated with lower Sexual Wellbeing (p=0.021) and trended toward lower Psychosocial Wellbeing (p=0.081) and Physical Wellbeing of Chest (p=0.081). PMRT showed interaction with the type of reconstruction, wherein autologous reconstruction significantly mitigated the negative impact of PMRT on Physical Wellbeing of Chest (p=0.006) and showed a trend for Satisfaction with Breasts (p=0.081).
Conclusions: Autologous and delayed reconstruction are associated with greater increases in QoL. Autologous reconstruction may mitigate negative effects associated with PMRT. These findings are important in an economic environment driving trends towards implant-based and immediate breast reconstruction.
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