by Seth, Akhil K.; Cordeiro, Peter G.
Plastic and
Reconstructive Surgery: September
2020 - Volume 146 - Issue 3 - p 474-484
Background:
Outcomes following prosthetic breast reconstruction have
been well studied. However, the majority of studies are limited by short-term
follow-up and a lack of aesthetic and patient-reported outcomes. This study
objectively examines long-term surgeon- and patient-reported outcomes following
two-stage prosthetic breast reconstruction.
Methods:
Consecutive patients undergoing two-stage prosthetic breast
reconstruction from 1994 to 2016 performed by the senior author (P.G.C.), with
at least 1-year follow-up after implant exchange, were reviewed
retrospectively. Long-term surgeon-reported outcomes, including aesthetic and
capsular contracture scores, and patient-reported outcomes using the BREAST-Q,
were recorded at each outpatient visit and analyzed over the 12-year follow-up
period.
Results:
Retrospective review revealed 2284 patients, or 3489
breasts, that fit the inclusion criteria. Aesthetic scores and capsular
contracture rates remained stable over the entire follow-up period. Subset
analysis demonstrated that bilateral and nonirradiated reconstructions
consistently had the highest aesthetic scores, whereas unilateral irradiated
breasts had the lowest. Irradiated breasts consistently had high rates of
capsular contracture, although the extent of contracture improved over time in
all patients. Patient-reported BREAST-Q scores showed either stability or
improvement over time in all patients. Irradiated and nonirradiated patients
demonstrated comparable long-term satisfaction with outcomes despite
significant differences in satisfaction with their breasts.
Conclusions:
The authors’ study, the largest of its kind, demonstrates
that prosthetic breast reconstruction outcomes do not deteriorate over time.
This stability is apparent in both long-term surgeon- and patient-reported
outcomes data measured in the same patients. These results contradict the
surgical dogma surrounding prosthetic breast reconstruction and therefore
should be given significant consideration when counseling patients. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
