Breast reconstruction

Satisfaction following immediate breast reconstruction: Experiences in the early post-operative stage

OBJECTIVES

This qualitative study aimed to achieve an understanding of women's experiences of immediate breast reconstruction following mastectomy, to better understand the factors influencing patient satisfaction.

DESIGN

Nine women were recruited from a breast unit in the North West of England. Participants were 3-9 months post-reconstruction, had received either an implant-based or Latissimus Dorsi-based immediate reconstruction and were not receiving any adjuvant therapies. An inductive qualitative and phenomenological approach was adopted to data collection and analysis.

METHODS

Women took part in semi-structured interviews. All interviews were transcribed and analysed using thematic analysis.

RESULTS

Four themes were generated: Seeking and receiving information; coping with the outcome of reconstruction; the need for on-going support and a new life after surgery.

CONCLUSION

The study highlights difficulties surrounding receiving information and decision-making, how women make sense of recovery, how they solicit and receive support, and the process by which they begin to make sense of their futures. More focus on these areas in service provision may aid positive psychological outcomes in the recovery process following immediate breast reconstruction.

From "no big deal" to "losing oneself": different meanings of mastectomy

BACKGROUND

Because of early detection and advanced treatment options, more women with breast cancer survive after mastectomy and thus have to face the choice of living with or without a reconstructed breast for many years to come.

OBJECTIVE

This article investigates these women's narratives about the impact of mastectomy on their lives, as well as their reflections on breast reconstruction.

METHODS

Fifteen women were strategically chosen from a previous population-based study on mastectomy. They were contacted for further exploration in thematic narrative-inspired interviews 4.5 years after mastectomy.

RESULTS

Three types of storylines were identified. In the first storyline, the mastectomy was described as "no big deal"; losing a breast did not disturb the women's view of themselves as women, and breast reconstruction was not even worth consideration. In the second storyline, the women described the mastectomy as shattering their identity. Losing a breast implied losing oneself as a sexual being, a woman, and a person. The third storyline fell in between the other two; the sense of femininity was wounded, but not to the extent that they felt lost as women.

CONCLUSION

Our findings suggest that the experience of mastectomy due to breast cancer is very much individual and contextual. Losing a breast may be of minor or major importance.

IMPLICATIONS FOR PRACTICE

Healthcare practitioners should be attentive to how the women themselves experience the personal meaning of losing a breast and guard against vague preconceptions based on the breast-sexuality-femininity discourse and its connection to what the patient needs.

Immediate latissimus dorsi pedicle flap reconstruction following the removal of an eight kilogram giant phyllodes tumour of the breast: a case report

INTRODUCTION

Phyllodes tumors account for less than 1% of breast tumors in women, and giant phyllodes tumors are those that are larger than 10 cm in diameter. Removal of such large tumors places a huge burden on the surgeon to reconstruct a breast that is aesthetically acceptable by the patient. We report what may be the largest giant phyllodes tumor and, most likely, the first latissimus dorsi flap used to cover such a large defect caused by the resection.

CASE PRESENTATION

We report the case of a 36-year-old Malaysian woman who presented with a three-year history of gradually increasing swelling of the left breast, with skin changes. Examination revealed a huge, globular, lobulated mass measuring 400 mm by 350 mm. The patient had a mastectomy with an immediate latissimus dorsi pedicled myocutaneous flap reconstruction. The breast weighed 8.27 kg, and ex vivo, the tumor measured 280 mm by 250 mm by 180 mm. Histopathologic analysis confirmed the diagnosis as a giant phyllodes tumor. At 12-month follow-up, the patient reports no complications and is satisfied with the aesthetic outcome.

CONCLUSION

Giant phyllodes tumors are very rare tumors that can reach up to 40 cm in diameter. Reconstruction of such a defect is a great challenge, and we report what we believe is the first latissimus dorsi flap to cover successfully a defect of approximately 400 mm by 350 mm.

Quality of life and satisfaction after breast cancer operation

PURPOSE

To investigate the quality of life and satisfaction after different operations in patients with breast cancer, which are breast conserving therapy (BCT), mastectomy and reconstruction after breast BCT or mastectomy.

MATERIALS AND METHODS

180 patients with breast cancer who were operated from January 2005 to October 2006 were chosen. They presented without local or distant metastasis in this period of time and were asked to complete the EORTC quality of life questionnaire (QLQ-C30), the EORTC breast cancer module questionnaire (QLQ-BR23) and a specific questionnaire regarding satisfaction of postoperative results designed by ourselves.

RESULTS

Of 112 (62.2%) patients who responded there were 76, 20 and 16 patients in the group of BCT, mastectomy and reconstruction, respectively. Compared with the mastectomy group and reconstruction group, the patients in BCT group had better body image (BI) (P = 0.004, P = 0.003), the patients in the group of reconstruction had more financial difficulties (FD) and more future perspective (FP) than the BCT group (P = 0.006, P = 0.039). Compared with the group of mastectomy and reconstruction, the patients in the group of BCT had a better self-assessment of postoperative results (P = 0.001, P < 0.001) and less visible postoperative scars (P = 0.003, P = 0.019). Patients in the reconstruction group thought that the difference in shape of the bilateral breast was more visible than in the BCT group (P = 0.005). Regarding visible differences in size of the breasts and satisfaction with the position and form of nipple-areolar complex, there were no differences between the two groups (P = 0.077, P = 0.272).

CONCLUSION

Patients with BCT have a better quality of life and higher satisfaction rate with their postoperative breasts compared to patients undergoing mastectomy or reconstructive surgery.