Patient-Reported Outcomes and Aesthetic Evaluations in Autologous Breast Reconstruction at Taipei Veterans General Hospital.

Abstract

Improving the quality of life increases patients' expectations of postmastectomy breast reconstruction. Increased incidence of breast implant-associated anaplastic large cell lymphoma encourages patients to choose autologous breast reconstruction over implantation. This study aimed to analyze the aesthetic outcomes of autologous breast reconstruction and define factors associated with the results. We recruited patients for immediate or delayed autologous tissue reconstruction after mastectomy from October 2015 to June 2021 at a single institute in Taiwan. Patient demographic data, operative complications, and secondary cosmetic revisions were identified through a medical chart review. Patient-reported outcomes (PROs) and perioperative imaging records were analyzed using the BREAST-Q questionnaire and Breast Cancer Conservation Treatment (BCCT).core, respectively, for aesthetic outcome evaluations. Eighty-three women were enrolled, with a 73% BREAST-Q questionnaire response rate, and followed-up for a mean 36 (6-78) months. The mean BREAST-Q score for satisfaction with breasts was 60.46 (standard deviation = 19.09). The postoperative BCCT.core evaluation did not differ significantly from the preoperative evaluation (P = 0.245), and most patients (70.59%) reported similar (50%) or better results (20.59%) after reconstruction. Postmastectomy radiotherapy impacted negatively on psychosocial well-being (P = 0.012), sexual well-being (P = 0.002), and satisfaction with breast (P = 0.026). Three-dimensional breast molds might improve psychosocial well-being BREAST-Q scores, sexual well-being, and breast satisfaction but was not statistically significant. Breast reconstruction with autologous tissue had an acceptable complication rate and favorable aesthetic outcomes in PROs and BCCT.core. Postmastectomy radiotherapy resulted in worse PROs and a 3-dimensional breast mold may facilitate better outcomes.