by Wu, Shannon S.; Duraes, Eliana F. R.; Scomacao, Isis;
Morisada, Megan; Djohan, Risal S.; Bernard, Steven L.; Moreira, Andrea;
Schwarz, Graham S.
Plastic and Reconstructive Surgery: July 2022 -
Volume 150 - Issue 1 - p 42e-50e
Background:
Patient-reported outcomes are the primary measurement of
breast reconstruction success, but results may be affected by nontechnical
factors such as socioemotional determinants. Third-party observers provide an
independent assessment of aesthetic outcomes. Factors associated with disparity
between patient and observer perceptions of outcomes are not well understood.
Methods:
One hundred forty-seven patients underwent breast
reconstruction at the authors’ institution between 2009 and 2011, completed the
BREAST-Q, and had photographs graded by a diverse panel using the Validated
Breast Aesthetic Scale. Patient satisfaction with breasts scores that aligned
with observer scores were categorized as group 2; patient satisfaction that
exceeded observer scores were group 1; and those lower than observer scores
were group 3. Statistical analysis was performed using SPSS, with values of p
< 0.05 considered statistically significant.
Results:
Twenty-eight patients (19 percent) were categorized as group
1, 93 (63 percent) in group 2, and 26 (18 percent) in group 3. Median overall
appearance was highest in group 3 (median, 4.0; interquartile range, 4 to 4)
and lowest in group 1 (median, 3.0; interquartile range, 2 to 3) (p <
0.001). Psychosocial, sexual, and physical well-being were significantly
associated with disparity (group 1 or 3 status) (p < 0.01). Satisfaction
with outcomes, nipples, abdomen, and breasts were significantly associated with
disparity. Factors not significantly associated with disparity include age,
body mass index, autologous or implant-based, adjuvant therapies, and timing of
reconstruction.
Conclusions:
Incongruously high patient satisfaction with breast
reconstruction aesthetics relative to third-party perception of aesthetic
outcomes is associated with high quality-of-life scores. Incongruously low
patient satisfaction with breast cosmesis compared with higher third-party
perceptions was associated with low quality-of-life scores. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Risk, II.
