by Ochoa, Oscar; Garza, Ramon III; Pisano, Steven;
Chrysopoulo, Minas; Ledoux, Peter; Arishita, Gary; Ketchum, Norma; Michalek,
Joel E.; Nastala, Chet
Plastic and Reconstructive Surgery: May 2022 -
Volume 149 - Issue 5 - p 848e-857e
Background:
Without reconstruction, mastectomy alone can produce
significant detrimental effects on health-related quality of life. The
magnitude of quality-of-life benefits following breast reconstruction may be
unique based on timing of reconstruction. Facilitated by the BREAST-Q
questionnaire, characterization of how reconstruction timing differentially
affects patient-reported quality of life is essential for improved
evidence-based clinical practice.
Methods:
Consecutive DIEP flap breast reconstruction patients prospectively
completed BREAST-Q questionnaires preoperatively and at two different time
intervals postoperatively. The first (postoperative time point A) and second
(postoperative time point B) postoperative questionnaires were completed 1
month postoperatively and following breast revision/symmetry procedures,
respectively. Postoperative flap and donor-site complications were recorded
prospectively. Stratified by timing (immediate versus delayed) of
reconstruction, preoperative clinical data, operative morbidity, and BREAST-Q
scores were compared at all time points.
Results:
Between July of 2012 and August of 2016, 73 patients
underwent 130 DIEP flap breast reconstructions. Collectively, breast
satisfaction, psychosocial well-being, and sexual well-being scores
significantly (p < 0.001) increased postoperatively versus baseline.
Chest and abdominal physical well-being scores returned to baseline levels by
postoperative time point B. Preoperatively, patients undergoing delayed breast
reconstruction reported significantly (p < 0.05) lower breast
satisfaction, psychosocial well-being, and sexual well-being scores compared to
immediate reconstruction patients. Postoperatively, delayed and immediate
reconstruction patients reported similar quality-of-life scores. Outcome
satisfaction and flap and donor-site morbidity were similar between groups
irrespective of timing of reconstruction.
Conclusions:
In this prospective study, patient-reported outcomes
demonstrate significant improvements in breast satisfaction, psychosocial
well-being, and sexual well-being among patients following DIEP flap
reconstruction. Moreover, preoperative differences in quality-of-life scores
among delayed/immediate reconstruction patients were eliminated
postoperatively.
