Understanding Breast Satisfaction in the Preoperative Breast Reconstruction Patient
Robert Allen, Jr., MD1, Meghana Shamsunder, MPH1, Thais Polanco, MD1, Aadit Patel, MD1, Nikhil Sobti, MS1, Colleen McCarthy, MD1, Evan Matros, MD MMSc MPH1, Joseph Dayan, MD1, Joseph Disa, MD1, Peter Cordeiro, MD1, Andrea Pusic, MD2, Babak Mehrara, MD1, Jonas Nelson, MD1.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Brigham and Women's Hospital, Boston, MA, USA.
Background: This study aims to delineate factors affecting preoperative breast satisfaction using the BREAST-Q in patients prior to post-mastectomy breast reconstruction.
Methods: Preoperative BREAST-Q data for women undergoing post-mastectomy breast reconstruction at a tertiary care center were prospectively collected from 2009 - 2017 as routine clinical care. The distribution of breast satisfaction scores failed normality assumptions for linear regression, therefore ordinal logistic regression was utilized. Scores were categorized into quartiles and age, BMI, race, Charlson Comorbidity Index (CCI), hypertension, diabetes, malignancy history, preoperative chemotherapy and radiation, and smoking were inputted as predictors into the model.
Results: Overall, 1,449 patients completed a preoperative BREAST-Q (median score: 58; 0-25th percentile score range: 0-48; 75th-100th percentile score range: 70-100). Regression analysis (Table 1) demonstrated that race, smoking, BMI, comorbid conditions, and malignancy history were significant predictors of preoperative breast satisfaction. African American patients were more likely to be satisfied than white patients. Previous and current smokers were less likely to be satisfied than non-smokers. Comorbidities impacted satisfaction, without clear trends. Increasing BMI was associated with lower satisfaction scores. Lastly, having a localized tumor was associated with increased preoperative satisfaction with breasts compared to having no malignancy history.
Conclusion: Multiple factors influence preoperative breast satisfaction. Understanding predictive factors affecting satisfaction with native breasts can lead to improved preoperative discussions, counseling and expectation management for subsequent breast reconstruction.
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