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Kim M, Gilliland JL, Parnes MF, Bruce C, Stern CS, Allen RJ, Pusic AL, Tadros AB, Nelson JA. BREAST-Q REACT: Qualitative Assessment of the Design, Functionality, and Clinical Utility of a New Score Interpretation Tool. Ann Surg Oncol 2024:10.1245/s10434-024-15185-0. [PMID: 38570377 DOI: 10.1245/s10434-024-15185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The BREAST-Q real-time engagement and communication tool (REACT) was developed to aid with BREAST-Q score interpretation and guide patient-centered care. OBJECTIVE The purpose of this qualitative study was to examine the perspectives of patients and providers on the design, functionality, and clinical utility of REACT and refine the REACT based on their recommendations. METHODS We conducted three patient focus groups with women who were at least 6 postoperative months from their postmastectomy breast reconstruction, and two provider focus groups with plastic surgeons, breast surgeons, and advanced practice providers. Focus groups were audio-taped, transcribed verbatim, and analyzed thematically. RESULTS A total of 18 breast reconstruction patients and 14 providers participated in the focus groups. Themes identified by thematic analysis were organized into two categories: (1) design and functionality, and (2) clinical utility. On the design and functionality of REACT, four major themes were identified: visual appeal and usefulness; contextualizing results; ability to normalize patients' experiences, noting participants' concerns; and suggested modifications. On the clinical utility of REACT, three major themes were identified: potential to empower patients to communicate with their providers; increase patient and provider motivation to engage with the BREAST-Q; and effective integration into clinical workflow. CONCLUSION Patients and providers in this qualitative study indicated that with some modifications, REACT has a great potential to elevate the clinical utility of the BREAST-Q by enhancing patient-provider communication that can lead to patient-centered, clinically relevant action recommendations based on longitudinal BREAST-Q scores.
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Affiliation(s)
- Minji Kim
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaime L Gilliland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mei-Fan Parnes
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cayla Bruce
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Lee MK, Hwang JW, Park JW, Woo KJ. Serial Comparison of Patient-Reported Outcomes of Immediate Breast Reconstruction: Direct-to-Implant Versus Deep Inferior Epigastric Perforator Flap. Aesthetic Plast Surg 2024; 48:1352-1361. [PMID: 37464217 DOI: 10.1007/s00266-023-03505-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Direct-to-implant (DTI) and deep inferior epigastric artery perforator (DIEP) flaps are the two most common methods of immediate breast reconstruction. This study aimed to compare patient-reported outcomes between the two methods and to evaluate whether outcomes change over time. METHODS The data of patients who underwent immediate breast reconstruction using DTI or DIEP flaps between July 2017 and October 2021 were retrospectively reviewed. Patients who completed the BREAST-Q Reconstruction Module at 6 months and > 12 months after reconstruction were analyzed. Mann-Whitney and Wilcoxon signed-rank test were used to compare outcome between DTI and DIEP groups, and serial comparisons were performed. RESULTS Of 375 patients included in the analysis, 146 patients completed questionnaires > 1 year of follow-up (20.79 ± 8.55 months). The DTI and DIEP groups had 102 (69.9%) and 44 (30.1%) patients, respectively. There were no intergroup differences in the mean scores representing any of the domains at 6 postoperative months. After > 1 year of follow-up, patients who underwent DIEP-flap reconstruction had greater satisfaction with their breast reconstructions (p < 0.001) and greater satisfaction with their overall outcomes (p < 0.001). In the DTI group, satisfaction scores did not change over time in any of the domains. In the DIEP group, however, the mean scores reflecting satisfaction with the breast (p = 0.001), overall outcome (p = 0.045), psychosocial well-being (p = 0.015), and sexual well-being (p = 0.042) significantly increased over long-term follow-up relative to the scores at 6 postoperative months. CONCLUSIONS Patient-reported outcomes improved over time in association with DIEP reconstructions, reflecting higher satisfaction levels than those associated with DTI reconstruction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mi Kyung Lee
- Department of plastic and reconstructive surgery, College of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Won Hwang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Jin-Woo Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Kyong-Je Woo
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea.
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Foley A, Choppa A, Bhimani F, Gundala T, Shamamian M, LaFontaine S, Tran D, Johnson K, Weichman K, Feldman S, McEvoy MP. Oncoplastic breast-conserving surgery (OBCS) vs. mastectomy with reconstruction: a comparison of outcomes in an underserved population. Gland Surg 2024; 13:358-373. [PMID: 38601288 PMCID: PMC11002483 DOI: 10.21037/gs-23-403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/10/2024] [Indexed: 04/12/2024]
Abstract
Background Oncoplastic breast-conserving surgery (OBCS) has demonstrated superior cosmetic outcomes to traditional breast-conserving surgery (BCS) while maintaining oncologic safety. While prior studies have compared OBCS to mastectomy, there is a scarcity of literature on the impact of social determinants of health on outcomes. Furthermore, although traditionally tumors larger than 5 cm and multifocal disease were treated with mastectomy, the literature has now shown OBCS to be safe in treating such disease. As a result, patients with large or multifocal tumors could be eligible for both mastectomy and OBCS, which prompts the need for comparison between the two. Thus, the aim of our study was to compare OBCS and mastectomy with reconstruction using BREAST-Q and oncologic outcome measures, as well as stratify these outcomes based on race, ethnicity, and body mass index (BMI). Methods A retrospective chart review was performed for 57 patients treated with OBCS and 204 patients treated with mastectomy with reconstruction from 2015 to 2021. Variables including age, race, ethnicity, BMI, insurance status, surgery type, pathology, recurrence, and complications were recorded. Patient-reported outcomes (PROs) were recorded using BREAST-Q pre- and post-operatively. Results Despite having a higher BMI (P<0.001), OBCS yielded higher "satisfaction with breast" and "satisfaction with outcome" than mastectomy (P=0.02 and P=0.02, respectively). When stratified by race, there were no statistical differences in the PROs between the two surgeries for Hispanic nor African American patients. OBCS had a significantly lower rate of infection and fewer additional surgeries than mastectomy (P=0.004 and P<0.001, respectively). There were no differences in positive margin rate or recurrence rate between the groups. Conclusions In our study, OBCS yielded better PROs than mastectomy while maintaining oncologic safety and resulting in fewer surgeries and complications. These excellent outcomes in a majority non-Caucasian cohort support the utilization of OBCS for underserved, minority populations. Larger studies evaluating PROs in diverse and uninsured groups are needed to reinforce these conclusions.
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Affiliation(s)
- Angela Foley
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Fardeen Bhimani
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
| | - Thoran Gundala
- Department of Obstetrics and Gynecology, Northwell - Long Island Jewish Medical Center/North Shore University Hospital, Manhasset, NY, USA
| | | | | | - David Tran
- Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
| | | | - Katie Weichman
- Hansjorg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Sheldon Feldman
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
| | - Maureen P. McEvoy
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
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Boudry T, Maisonnette Escot Y, Pluvy I, Feuvrier D, Houvenaeghel G, Ramanah R. [RECOMA study: Evaluation of quality of life and satisfaction after immediate or delayed breast reconstruction]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00089-8. [PMID: 38513889 DOI: 10.1016/j.gofs.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Breast reconstruction after mastectomy, whether immediate or delayed, is an integral part of the overall management of breast cancer. However, up to 40 % of reconstructed patients are not satisfied with the aesthetic result. The primary objective of the study was to evaluate satisfaction and quality of life according to the reconstruction techniques used in our center. The secondary objectives were to identify the parameters that could influence satisfaction and quality of life after surgery, to list the main complications, and the number of operations required to consider the reconstruction process as completed. METHOD A retrospective monocentric study, RECOMA, was carried out at the CHRU Minjoz in Besançon. All patients who underwent immediate or delayed breast reconstruction between 2010 and 2021 were contacted by post or e-mail and asked to complete the standardized BREAST-Q postoperative module. RESULTS Of 508 patients contacted, 149 were included. Reconstructed patients reported satisfaction, but also "average" quality of physical and psychological sexual life. Only the surgeon's assessment was rated as "good". There was no significant difference in satisfaction and quality of life depending on the reconstruction method chosen. On the other hand, patients who underwent nipple areolar complex (NAC) reconstruction had a significantly higher psychic quality of life score (P=0.02). In addition, a significant decrease in physical satisfaction was observed over time(P=0.049). An average of 2.4 operations was required to consider breast reconstruction complete. CONCLUSION In our opinion, breast reconstruction is an essential procedure to be considered as soon as the indication for mastectomy is given, but it is a process that requires the patient to be prepared for a result that may be weaker than expected, may require several operations, and may be complicated.
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Affiliation(s)
- Thibaud Boudry
- Département de chirurgie gynécologie et obstétrique, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France.
| | - Yolande Maisonnette Escot
- Département de chirurgie gynécologie et obstétrique, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - Isabelle Pluvy
- Département de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Unité de recherche Nanomedicine Lab, Imagery & Therapeutics EA4662, université de Bourgogne-Franche-Comté, 16, route de Gray, 25030 Besançon, France
| | - Damien Feuvrier
- Département de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - Gilles Houvenaeghel
- Institut Paoli Calmettes & CRCM, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Faculté de médecine Timone, université Aix-Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - Rajeev Ramanah
- Département de chirurgie gynécologie et obstétrique, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Unité de recherche Nanomedicine Lab, Imagery & Therapeutics EA4662, université de Bourgogne-Franche-Comté, 16, route de Gray, 25030 Besançon, France
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Olasehinde O, Lynch KA, Goldman DA, Agodirin O, Okereke C, Wuraola FO, Owoade IA, Akinmaye PR, Ajibade O, Barber K, Ogunwale J, Alatise O, Kingham TP, Pusic A, Romanoff A. Translation and psychometric assessment of the mastectomy module of the BREAST-Q questionnaire for use in Nigeria. J Patient Rep Outcomes 2024; 8:17. [PMID: 38334903 PMCID: PMC10857998 DOI: 10.1186/s41687-024-00692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The majority of non-metastatic breast cancer patients in sub-Saharan Africa are recommended to have mastectomy. The impact of mastectomy on a predominantly young African patient population requires evaluation. The BREAST-Q is a validated patient-reported outcome measure of quality-of-life following breast surgery that has been translated into 30 languages-none in Africa. This study aimed to translate and assess the psychometric properties of the mastectomy module of the BREAST-Q for use in Nigeria. METHODS The BREAST-Q mastectomy module was translated from English to Yoruba and its psychometric properties assessed using best practice guidelines. Translation was performed in 4 steps: forward translation (x2), back translation, back translation review, and cognitive interviews with post-mastectomy patients. The translated BREAST-Q instrument was administered to post-mastectomy patients (n = 21) alongside the EORTC-QLQ BR23 to evaluate construct validity. Test-retest reliability was evaluated using intraclass correlation coefficients (ICC); surveys were re-administered 4 weeks apart. RESULTS The translation process identified English phrases not amenable to direct translation, including "emotionally healthy" and descriptions of pain ("nagging," "throbbing," "sharp"). Translations were amended to reflect local context and question intent. During cognitive interviews, patients provided suggestions to simplify complex phrases, e.g. "discomfort in your breast area.". Internal consistency within scales was over 0.70 for psychosocial wellbeing (α = 0.84-0.87), sexual wellbeing (α = 0.98-0.99), physical wellbeing in chest (α = 0.84-0.86), and satisfaction with care (α = 0.89-0.93). ICC for test-retest reliability was moderate (0.46-0.63). CONCLUSIONS The Yoruba version of the BREAST-Q mastectomy module presents a unique opportunity to adequately capture the experiences of Nigerian women post mastectomy. This instrument is being used in a pilot study of Nigerian patients to identify targets for intervention to improve the patient experience and compliance with breast cancer surgery.
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Affiliation(s)
- Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
- African Research Group for Oncology, Osun, Nigeria
| | - Kathleen A Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, USA.
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olaide Agodirin
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- African Research Group for Oncology, Osun, Nigeria
| | - Chukwuma Okereke
- Department of Surgery, Federal Medical Center Owo, Owo, Nigeria
- African Research Group for Oncology, Osun, Nigeria
| | - Funmilola O Wuraola
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
- African Research Group for Oncology, Osun, Nigeria
| | | | | | - Olusola Ajibade
- Department of Linguistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Karin Barber
- Department of African Studies and Anthropology School of History and Cultures, University of Birmingham, Birmingham, UK
| | - Joshua Ogunwale
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olusegun Alatise
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
- African Research Group for Oncology, Osun, Nigeria
| | - T Peter Kingham
- African Research Group for Oncology, Osun, Nigeria
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Anya Romanoff
- Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mott NM, Huynh V, Vemuru S, Parris HJ, Colborn K, Ahrendt G, Christian N, Kim S, Matlock DD, Cumbler E, Tevis SEA. Barriers and facilitators to measuring patient reported outcomes in an academic breast cancer clinic: An application of the RE-AIM framework. Am J Surg 2024; 228:180-184. [PMID: 37741803 PMCID: PMC11044988 DOI: 10.1016/j.amjsurg.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/14/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Patient reported outcome measures (PROMs) are important for patient-centered, value-based care; however, implementation into surgical practice remains limited. We aimed to demonstrate feasibility of measuring PROMs in an academic breast cancer clinic. METHODS We conducted a pilot study implementing the patient-reported outcome measure BREAST-Q among patients with Stage 0-III breast cancer at a single institution from 06/2019-03/2023 using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Barriers and facilitators were characterized. Survey completion was assessed pre-operatively and up to 12 months post-operatively. RESULTS Barriers included limited time and lack of incorporation into the electronic medical record. Facilitators included utilizing trained team members and an automated workflow. Among eligible patients, 74% completed BREAST-Q at 2-weeks post-operatively and 55% at 12 months post-operatively. CONCLUSIONS We describe the implementation of a PROM using the RE-AIM framework, highlighting facilitators and barriers that may assist others in collecting patient-reported outcome data.
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Affiliation(s)
- Nicole M Mott
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Victoria Huynh
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Sudheer Vemuru
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Hannah J Parris
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Gretchen Ahrendt
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Nicole Christian
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Simon Kim
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Daniel D Matlock
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Ethan Cumbler
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA
| | - Sarah E A Tevis
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA.
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Christodoulides N, Sheahan CR, Dhannoon A, Marino S, Dolan RT, Jalil KIA, Martin-Smith JD. Assessment of patient-reported satisfaction following DIEP flap breast reconstruction in patients with a low BMI: A single unit experience. J Plast Reconstr Aesthet Surg 2024; 89:142-143. [PMID: 38181635 DOI: 10.1016/j.bjps.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024]
Affiliation(s)
| | - Conor R Sheahan
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - Amenah Dhannoon
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - Silvia Marino
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - Roisin T Dolan
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - James D Martin-Smith
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
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Park JB, Rahmani B, Adebagbo OD, Chen A, Garvey SR, Escobar-Domingo MJ, Gettings M, Cauley RP. Impact of sternal notch-to-nipple distance and resection weight asymmetry on complication rates and patient reported outcomes in reduction mammaplasty. J Plast Reconstr Aesthet Surg 2024; 88:340-343. [PMID: 38061258 DOI: 10.1016/j.bjps.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 01/02/2024]
Abstract
While there are numerous predictive models for estimating resection weight, their accuracy may not be strong. Through institutional data of patients who received reduction mammaplasty, this study demonstrates that preoperative sternal notch-to-nipple distance is not an optimal predictive factor for differences in final resection weight, complication rates, and patient reported outcomes. Our results showed that there is a weak correlation between preoperative sternal notch to nipple asymmetry and final resection weight asymmetry. Additionally, significant breast asymmetry is not tied to an increase in complication rates or poorer patient reported outcomes. There is an indication to reconsider the use of such absolute measures for determining who may benefit from reduction mammaplasty.
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Affiliation(s)
- John B Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Benjamin Rahmani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Oluwaseun D Adebagbo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Amy Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shannon R Garvey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Maria J Escobar-Domingo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Macie Gettings
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Kuhlefelt C, Repo JP, Jahkola T, Kauhanen S, Homsy P. Immediate versus delayed breast reconstruction: Long-term follow-up on health-related quality of life and satisfaction with breasts. J Plast Reconstr Aesthet Surg 2024; 88:478-486. [PMID: 38101261 DOI: 10.1016/j.bjps.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Health-related quality of life (HRQL) can be improved by breast reconstruction following mastectomy. The optimal timing of the reconstruction remains unclear. METHODS A cross-sectional study on 338 women who had undergone immediate or delayed breast reconstruction between 08/2017 and 07/2019 was performed. The postoperative HRQL was assessed using the BREAST-Q Reconstruction Module and the 36-Item Short Form Survey (SF-36). Regression analysis was performed for group-wise comparison. RESULTS A total of 146 (43%) patients participated. Seventy-seven patients (53%) had undergone immediate, and 69 patients (47%) had delayed reconstruction. The median age was 55 years (interquartile ratio [IQR] 50-62) for the Immeda group te, and 60 years (IQR 54-65) for the delayed reconstruction group. The median follow-up time was 2.3 years (IQR 1.8-2.9). No difference between the groups was detected in satisfaction with breasts (median 61, IQR 53-71 vs. 62, IQR 46-71, p = 0.62), physical well-being of the chest (median 100, IQR 80-100 vs. 100, IQR 80-100, p = 0.95) or psychosocial well-being (median 69, IQR 54-83 vs. 62, IQR 54-74, p = 0.19). No difference was detected in the SF-36 domains either. CONCLUSIONS The timing of the breast reconstruction does not affect the postoperative HRQL. Patients with both immediate and delayed breast reconstruction reported high satisfaction with the breast and psychosocial well-being.
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Affiliation(s)
- Charlotta Kuhlefelt
- Division of Musculoskeletal and Plastic Surgery, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Park Hospital, PB 281, 00029 HUS Helsinki, Finland.
| | - Jussi P Repo
- Unit of Musculoskeletal Disease, Department of Orthopedics and Traumatology, Tampere University Hospital and University of Tampere, PB 2000, FI-33521 Tampere, Finland
| | - Tiina Jahkola
- Division of Musculoskeletal and Plastic Surgery, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Park Hospital, PB 281, 00029 HUS Helsinki, Finland
| | - Susanna Kauhanen
- Division of Musculoskeletal and Plastic Surgery, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Park Hospital, PB 281, 00029 HUS Helsinki, Finland
| | - Pauliina Homsy
- Division of Musculoskeletal and Plastic Surgery, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Park Hospital, PB 281, 00029 HUS Helsinki, Finland
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10
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Hsieh WC, Tee R, Huang YT, Kuo WL, Huang JJ. Surgical and patient-reported outcomes in an Asian female population with or without adjuvant radiotherapy after immediate free perforator flap breast reconstruction: A retrospective review. JPRAS Open 2023; 38:237-248. [PMID: 38021323 PMCID: PMC10630550 DOI: 10.1016/j.jpra.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background The majority of English literature has reported on the somewhat conflicted outcomes of the effect of radiotherapy on immediate breast reconstruction. However, data specifically related to patients of Asian descent has been scarce. This retrospective study aims to shed light on this topic to aid in the management of this group of patients. Methods All patients who received immediate free perforator flap-based breast reconstruction under a single surgeon over a 10-year period were included in the study. Patient characteristics, oncological and surgical data were collected. Patients were divided into post-mastectomy radiotherapy (PMRT) and non-PMRT groups. The final aesthetic outcome was assessed by a surgeon-reported outcome questionnaire. Patient satisfaction and psychological outcomes were assessed using validated patient-reported outcome (PRO) questionnaire (BREAST-Q), breast reconstruction, and postoperative module. Results A total of 101 women, with an average age of 44.7 ± 8.4 underwent perforator flap-based reconstruction. Fifteen patients received PMRT, with remaining 86 patients in the non-PMRT group. The mean duration of follow-up was over 5 years (p = 0.514). The recurrence rate was acceptable in the PMRT group (3/15, p = 0.129). There were no significant differences in complication rates between the two groups (p = 1.000). The aesthetic outcomes were comparable (p = 0.342). PRO appears to be lower in the PMRT group. Conclusions Immediate breast reconstruction with PMRT in the local patient cohort is oncologically safe, acceptable complication profile, revision rate, and aesthetic outcome. PRO showed lower scores in several categories, which differ from normative data generated in the Western population. Further studies will need to examine the confounding effects of radiation in this specific population.
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Affiliation(s)
- Wei-Chuan Hsieh
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Richard Tee
- Department of Plastic and Reconstructive Surgery, Western Health, Melbourne, Australia
| | - Yi-Ting Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Wen-Ling Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Jung-Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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11
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Maheta B, Yesantharao PS, Thawanyarat K, Akhter MF, Rowley M, Nazerali RS. Timing of autologous fat grafting in implant-based breast reconstruction: Best practices based on systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 86:273-279. [PMID: 37797375 DOI: 10.1016/j.bjps.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Fat grafting is commonly undertaken as a third-stage procedure in patients with staged implant-based breast reconstruction (IBR). However, fat grafting performed during second-stage expander/implant exchange provides faster results without an additional procedure and associated risks (Patel et al., 2020). We previously demonstrated that fat grafting during second-stage expander/implant exchange did not increase clinical complications (Patel et al., 2020). As a corollary, this study investigates patients' satisfaction with second- versus third-stage fat grafting to help establish a set of best practices for the timing of fat grafting in such patients. METHODS A review of PubMed/MEDLINE databases (2010-2022) was performed to identify articles investigating the quality of life in patients undergoing second- or third-stage fat grafting after IBR. BREAST-Q scores were pooled using random-effects modeling and the DerSimonian-Laird method. Post-hoc sensitivity analyses were completed using the Hartung-Knapp-Sidik-Jonkman method. The Haldane-Anscombe correction was used for outcomes with low counts. All study analyses adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Six studies (216 patients) were included. Pooled random-effects modeling demonstrated no significant changes in BREAST-Q satisfaction with outcome scores when comparing patients who received second- versus third-stage fat grafting (p = 0.178) with results robust to sensitivity analyses. In addition, pooled analyses of the available data demonstrated that second-stage fat grafting did not increase downstream revision surgery needs compared to third-stage fat grafting. CONCLUSIONS In combination with our prior work, this meta-analysis suggests that second-stage fat grafting provides not only equivalent but improved clinical and quality of life outcomes with fewer procedures in patients undergoing expander/IBR.
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Affiliation(s)
- Bhagvat Maheta
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Pooja S Yesantharao
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kometh Thawanyarat
- Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, GA, USA
| | - Maheen F Akhter
- Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Mallory Rowley
- State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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12
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Woussen A, Pluvy I, Maisonnette Y, Chaput B, Ferreira D, Feuvrier D. Interest of acellular dermal matrices in immediate breast reconstruction: Comparison of quality of life and complications with and without matrix. J Plast Reconstr Aesthet Surg 2023; 86:128-138. [PMID: 37716249 DOI: 10.1016/j.bjps.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Since 2001, acellular dermal matrices have been increasingly used in immediate breast reconstruction (IBR) because they allow for the placement of the ideal-sized definitive implant in one step. They are used in both retropectoral and prepectoral prosthetic breast reconstructions. The aim of this study was to evaluate the impact of dermal matrices on the quality of life and on complications. MATERIALS AND METHODS Two surveys were used to evaluate the quality of life: the BREAST-Q V2.0© and the QuickDASH. The surveys were sent to all patients who had an immediate prosthetic breast reconstruction at a University Hospital Center from 2010 to 2020. A case-control study was performed for comparison of responses between the "Matrix+" and "Matrix-" groups. RESULTS Seventeen IBR with matrix (23.6%) and 55 IBR without matrix (76.4%) were analyzed. Patients in the "Matrix+" group had a better quality of life in terms of sexual well-being (p = 0.038) and a significantly lower QuickDASH (p < 0.01). They had better breast satisfaction (p = 0.016) and better implant satisfaction (p < 0.01). The likelihood of encountering major complications later in time was more important in the group with matrix (p = 0.04). CONCLUSION We found a satisfactory quality of life with scores of sexual well-being and satisfaction with the breast and the implants, and a better satisfaction with care thanks to the use of the matrices. However, due to a higher number of major late complications and a lack of follow-up, we believe that immediate prosthetic breast reconstruction with matrix should be discussed according to the comorbidities, medical treatments, and the vitality of the skin flaps of each patient.
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Affiliation(s)
- Aurore Woussen
- Department of Orthopaedic and Trauma Surgery, Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, CHRU Minjoz, 3, Boulevard Alexander-Fleming, 25030 Besançon Cedex, France.
| | - Isabelle Pluvy
- Department of Orthopaedic and Trauma Surgery, Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, CHRU Minjoz, 3, Boulevard Alexander-Fleming, 25030 Besançon Cedex, France
| | - Yolande Maisonnette
- Department of Gynaecology-Obstetrics, CHRU Minjoz, 3, Boulevard Alexander-Fleming, 25030 Besançon Cedex, France
| | - Benoit Chaput
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, CHRU Rangueil, 1 Avenue du Professeur Jean Poulhes, 31400 Toulouse, France
| | - David Ferreira
- Department of Anesthesia, CHRU Minjoz, 3, Boulevard Alexander-Fleming, 25030 Besançon Cedex, France
| | - Damien Feuvrier
- Department of Orthopaedic and Trauma Surgery, Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, CHRU Minjoz, 3, Boulevard Alexander-Fleming, 25030 Besançon Cedex, France
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13
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Pak LM, Matar-Ujvary R, Verdial FC, Haglich KA, Sevilimedu V, Nelson JA, Gemignani ML. Long-Term Patient-Reported Outcomes Comparing Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery: A Propensity Score-Matched Analysis. Ann Surg Oncol 2023; 30:7091-7098. [PMID: 37556008 PMCID: PMC10996134 DOI: 10.1245/s10434-023-13962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/03/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Oncoplastic breast surgery (OBS) combines plastic surgery techniques with conventional breast-conserving surgery (BCS) and expands BCS eligibility. Limited data are available on patient-reported outcomes (PROs) after OBS. Here we compare long-term PROs after OBS and BCS utilizing the BREAST-Q. PATIENTS AND METHODS Women undergoing OBS or BCS between 2006 and 2019 who completed ≥ 1 long-term BREAST-Q survey 3-5 years postoperatively were identified. Baseline characteristics were compared between women who underwent OBS/BCS. Women who underwent OBS were paired with those who underwent BCS using 1:2 propensity matching [by age, body mass index (BMI), race, T stage, and multifocality]. BREAST-Q scores were compared preoperatively and 3-5 years postoperatively. RESULTS A total of 297 patients were included for analysis (99 OBS/198 BCS). Women who underwent OBS were younger (p < 0.001) and had higher BMI (p = 0.005) and multifocal disease incidence (p = 0.004). There was no difference between groups in nodal stage, re-excision rates, axillary surgery, chemotherapy, endocrine therapy, or radiotherapy. After propensity matching preoperatively, women who underwent OBS reported lower psychosocial well-being (63 versus 100, p = 0.039) but similar breast satisfaction and sexual well-being compared with women who underwent BCS; however, only three patients who underwent BCS had preoperative BREAST-Q scores available for review. In long-term follow-up, women who underwent OBS reported lower psychosocial scores (74 versus 93, p = 0.011) 4 years postoperatively, but not at 5 years (76 versus 77, p = 0.83). There was no difference in long-term breast satisfaction or sexual well-being. CONCLUSIONS Women who undergo OBS present with a larger disease burden and may represent a group of non-traditional BCS candidates; they reported similar long-term breast satisfaction and sexual well-being compared with women who undergo BCS. While women who underwent OBS reported lower psychosocial well-being scores preoperatively and during a portion of the follow-up period, this difference was no longer seen at 5 years postoperatively.
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Affiliation(s)
- Linda M Pak
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Regina Matar-Ujvary
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Francys C Verdial
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kathryn A Haglich
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
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14
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Ghilli M, Mariniello MD, Ferrè F, Morganti R, Perre E, Novaro R, Colizzi L, Camilleri V, Baldetti G, Rossetti E, Coletti L, Scatena C, Ghilardi M, Cossu MC, Roncella M. Quality of life and satisfaction of patients after oncoplastic or traditional breast-conserving surgery using the BREAST-Q (BCT module): a prospective study. Breast Cancer 2023; 30:802-809. [PMID: 37358721 PMCID: PMC10404206 DOI: 10.1007/s12282-023-01474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION The oncoplastic conservative surgery was developed as a natural evolution of traditional surgery, attempting to improve the therapeutic and aesthetic outcomes where tumor resection could be followed by not-adequate results. Our primary aim is to evaluate how patient satisfaction and quality-of-life after conservative oncoplastic surgery, using BREAST-Q (BCT Module), change pre- and post-operatively. The secondary aim is to compare patient-reported outcome after oncoplastic or traditional conservative surgery. PATIENTS AND METHODS We enrolled 647 patients who underwent traditional conservative surgery or oncoplastic surgery from January 2020 to December 2022. Only 232 women (35.9%) completed the BREAST-Q questionnaire on a web-based platform, at the preoperative phase and 3 months after treatment. RESULTS The average score of "Psychosocial well-being" and "Satisfaction with Breasts" 3 months after surgery showed a statistically significant improvement, while the average score for "Physical well-being: Chest" at 3 months showed a worsening compared to the baseline. "Sexual well-being" did not show statistically significant change. A significant difference between the post-operative outcome of oncoplastic surgery and traditional surgery was observed only for Physical well-being (better for traditional surgery). CONCLUSIONS The study showed significant improvement in patient-reported outcomes 3 months after the surgery, except for physical discomfort that increases especially after oncoplastic surgery. Furthermore, our data, as well as many others, point to the appropriateness of using OCS where there is an effective indication, while the perspective of patients cannot find significant superiority over TCS in any of the areas analyzed.
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Affiliation(s)
- M Ghilli
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy.
| | - M D Mariniello
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - F Ferrè
- Scuola Superiore Sant'Anna of Pisa, Laboratorio Management E Sanità, Istituto di Management, Pisa, Italy
| | - R Morganti
- Unit of Statistics, University Hospital of Pisa, Pisa, Italy
| | - E Perre
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - R Novaro
- Scuola Superiore Sant'Anna of Pisa, Laboratorio Management E Sanità, Istituto di Management, Pisa, Italy
| | - L Colizzi
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - V Camilleri
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - G Baldetti
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - E Rossetti
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - L Coletti
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - C Scatena
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - M Ghilardi
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - M C Cossu
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
| | - M Roncella
- Breast Centre AOUP, University Hospital of Pisa, Pisa, Italy
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15
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Arora N, Patel R, Sohi G, Merchant S, Martou G. A Scoping Review of the Application of BREAST-Q in Surgical Research. JPRAS Open 2023; 37:9-23. [PMID: 37288429 PMCID: PMC10242639 DOI: 10.1016/j.jpra.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/30/2023] [Indexed: 06/09/2023] Open
Abstract
Background Collection of patient-reported outcome (PRO) data can facilitate cost-effective, evidence-based, and patient-centered care. The BREAST-Q has become the gold standard tool to measure PRO data in breast surgery. The last review of its application indicated that it was underutilized. Considering the evolution in breast surgery, the purpose of this study was to perform a scoping review of BREAST-Q application since 2015 and identify emerging trends and potential persistent gaps to guide patient-centered practice and future research in breast surgery. Methods We performed an electronic literature review to identify publications published in English that used the BREAST-Q to assess patient outcomes. We excluded validation studies, review papers, conference abstracts, discussions, comments, and/or responses to previously published papers. Results We identified 270 studies that met our inclusion criteria. Specific data was extracted to examine the evolution of the BREAST-Q application and examine clinical trends and research gaps. Discussion Despite a significant increase in BREAST-Q studies, gaps in the understanding of the patient experience remain. The BREAST-Q is uniquely designed to measure quality of life and satisfaction with outcome and care. The prospective collection of center-specific data for every type of breast surgery will generate important information for the provision of patient-centered and evidence-based care.
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Affiliation(s)
- Nikita Arora
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Ruchit Patel
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Gursharan Sohi
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Shaila Merchant
- Division of General Surgery and Surgical Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Glykeria Martou
- Division of Plastic Surgery and Surgical Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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16
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Baxter CR, Crittenden TA, Dean NR. Self-reported breast size, exercise habits and BREAST-Q data - an international cross-sectional study of community runners. JPRAS Open 2023; 37:92-101. [PMID: 37457991 PMCID: PMC10339238 DOI: 10.1016/j.jpra.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Women with larger breasts tend not to participate in high-intensity exercise and exercise less frequently. This study investigates how breast size impacts exercise habits and how breast reduction surgery changes women's participation in recreational exercise. Recruitment was generated via parkrun Limited (Richmond, UK), an organization offering weekly community-based runs. Female parkrun members aged over 18 years with no history of breast cancer were invited to complete a survey, including questions about their exercise habits, breast size, any breast alteration surgery, and BREAST-Q questionnaires. A total of 1987 women completed the survey, including 56 women who had undergone breast reduction. Results demonstrate that women with bigger breasts believe that reducing their breast size would improve their exercise performance and participation and that their breast size significantly impacts their type of exercise. Women who had undergone breast reduction reported increased overall frequency, enjoyment, and willingness to exercise in a group. Additionally, women that have undergone breast reduction report higher BREAST-Q scores than their non-surgical counterparts. This study supports the existing literature that breast size can impact exercise habits and demonstrates that women who have undergone breast reduction participate in healthier lifestyle practices. We suggest that if breast size impacts women's participation in sport and fitness, health practitioners and policymakers should advocate for better access to reduction mammoplasty in the publicly funded health sector.
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Affiliation(s)
- Claire R. Baxter
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Tamara A. Crittenden
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Nicola R. Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
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Martínez-Pérez JL, Pascual-Dapena A, Pardo Y, Ferrer M, Pont À, López MJ, Nicolau P, Jiménez M, Masó P, Vernet-Tomás M, Argudo N. Validation of the Spanish electronic version of the BREAST-Q questionnaire. Eur J Surg Oncol 2023; 49:1417-1422. [PMID: 37179146 DOI: 10.1016/j.ejso.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) have gained considerable interest in health care moving beyond traditional outcome measures of morbidity and mortality. In breast cancer surgery, women's' perceptions of appearance, function and quality of life have become increasingly important. The BREAST-Q questionnaire is a validated PROM for use in cosmetic and reconstructive breast surgery in clinical practice. The objective of this study was to validate the Spanish electronic version of the BREAST-Q questionnaire, to verify the measurement equivalence of digital and paper versions and to identify the possible disadvantages and advantages of implementing this new tool. METHODS The study population included 113 patients undergoing breast cancer survey at a single hospital in Barcelona (Spain) who were able to complete both the electronic and paper versions of the preoperative module of the BREAST-Q questionnaire. RESULTS The intraclass correlation coefficient (ICC) in the four domains of the questionnaire between the two versions of the questionnaire was >0.9, with a weighted kappa of >0.74 at item level. The reliability of the internal consistency was also excellent, with Cronbach's alpha coefficient of >0.70 in all domains. Age was a limiting factor for the delivery of the electronic version of BREAST-Q, with 69 years of age as the cut-off point to obtain reliable results. CONCLUSIONS The interchangeability of the electronic and paper versions of the BREAST-Q questionnaire facilitates implementation of this instrument in routine surgical oncological practice.
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Affiliation(s)
- Juan Luis Martínez-Pérez
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Ana Pascual-Dapena
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Yolanda Pardo
- Health Services Research Unit, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain; Department de Psiquiatria I Medicina legal, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red, Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Montserrat Ferrer
- Health Services Research Unit, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red, Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Àngels Pont
- Health Services Research Unit, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.
| | | | - Pau Nicolau
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Breast Diseases Unit, Hospital Del Mar, Barcelona, Spain; Department of Obstetrics and Gynecology Department, Hospital Del Mar, Barcelona, Spain.
| | - Marta Jiménez
- Breast Diseases Unit, Hospital Del Mar, Barcelona, Spain; Department of General Surgery, Hospital Del Mar, Barcelona, Spain.
| | - Paula Masó
- Breast Diseases Unit, Hospital Del Mar, Barcelona, Spain; Department of Obstetrics and Gynecology Department, Hospital Del Mar, Barcelona, Spain.
| | - María Vernet-Tomás
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Breast Diseases Unit, Hospital Del Mar, Barcelona, Spain; Department of Obstetrics and Gynecology Department, Hospital Del Mar, Barcelona, Spain.
| | - Nuria Argudo
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Breast Diseases Unit, Hospital Del Mar, Barcelona, Spain; Department of General Surgery, Hospital Del Mar, Barcelona, Spain.
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Fernando H, Noelia G, Maria E, Pedro M. Centrally located breast carcinomas treated with central quadrantectomy and immediate nipple-areola reconstruction: a cohort study. Breast Cancer 2023; 30:552-558. [PMID: 36867348 DOI: 10.1007/s12282-023-01445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Mastectomy has often been cited as the favoured option for centrally located breast tumours because lumpectomies or quadrantectomies that remove the nipple-areola complex often result in poor cosmesis. Currently, breast-conserving treatment is a preferred treatment for centrally located breast tumours, but this approach requires oncoplastic breast technique to avoid aesthetic sequels. This article describes the use of breast reduction techniques with immediate nipple-areola complex reconstruction (utilised to treat breast cancer) for centrally sited breast tumours PATIENTS: Ten patients suffering from a centrally located breast carcinoma were treated at our breast unit over a period of 16 years (2006-2022). Oncologic and patient-reported outcomes were updated revising electronic reports and surveying with BREAST-Q module Breast conserving therapy (version 2, Spanish) postoperative scales. RESULTS Excision margins were complete in all cases. There have been no postoperative complications, all patients are alive and no cases of recurrence after 84.8 months of mean follow-up. Patients score the domain satisfaction with breast: mean 61.7 (Standard deviation 12.5) out of 100. CONCLUSIONS Breast reduction mammaplasty with immediate nipple-areola complex reconstruction allows surgeons to carry out a central quadrantectomy to treat centrally located breast carcinoma with good oncologic and cosmetic outcome.
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Affiliation(s)
- Hernanz Fernando
- Breast Unit, Hospital Valdecilla, University of Cantabria, Avda. Valdecilla Sn, 39008, Santander, Cantabria, Spain.
| | - González Noelia
- Breast Unit, Hospital Valdecilla, University of Cantabria, Avda. Valdecilla Sn, 39008, Santander, Cantabria, Spain
| | - Esteban Maria
- Breast Unit, Hospital Valdecilla, University of Cantabria, Avda. Valdecilla Sn, 39008, Santander, Cantabria, Spain
| | - Muñoz Pedro
- Servicio Cántabro de Salud (SCS), Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
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Peshel EC, McNary CM, Barkach C, Boudiab EM, Vega D, Nossoni F, Chaiyasate K, Powers JM. Systematic Review of Patient-Reported Outcomes and Complications of Pedicled Latissimus Flap Breast Reconstruction. Arch Plast Surg 2023; 50:361-369. [PMID: 37564714 PMCID: PMC10411213 DOI: 10.1055/a-2045-8122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
The latissimus dorsi (LD) flap is a reliable option for breast reconstruction. This is particularly true in patients with contraindications to abdominally based autologous breast reconstruction. A systematic review of patient satisfaction and health related quality of life following LD breast reconstruction using the BREAST-Q survey was conducted. The scope of the review was to determine the degree of patient satisfaction following the procedure and to examine how patient satisfaction from the pedicled LD flap compares to other breast reconstructive procedures. A literature search on BREAST-Q in LD flap reconstruction was performed. Only articles written in English and in published peer-reviewed journals were included. Studies with less than 20 patients in their sample and those with a follow-up period of less than 1 year were excluded. Five articles representing 331 patients were reviewed, including one case-control study and four retrospective cohort studies. Level of evidence was either III (4) or IV (1). The average age was 53 with average body mass index of 25. Most reconstructions were delayed (67%) and unilateral (88%), and most patients required radiation (79%). The average length of follow-up was 36 months, and the response rate was 75%. Overall, patients who underwent LD flap reconstruction reported favorable outcomes in satisfaction domains and quality of life domains with few complications. A meta-analysis also demonstrated higher satisfaction in LD flap without implants compared with LD flap with implants. Patient-reported outcomes following LD breast reconstruction compare favorably with other techniques of breast reconstruction.
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Affiliation(s)
- Emanuela C. Peshel
- Division of General Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Claire M. McNary
- Department of Surgery, Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Catherine Barkach
- Department of Surgery, Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | | | - Daniella Vega
- Division of Plastic and Reconstructive Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Farid Nossoni
- Division of Plastic and Reconstructive Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Kongkrit Chaiyasate
- Department of Surgery, Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
- Division of Plastic and Reconstructive Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Jeremy M. Powers
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
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Kaur MN, Chan S, Bordeleau L, Zhong T, Tsangaris E, Pusic AL, Cano SJ, Klassen AF. Re-examining content validity of the BREAST-Q more than a decade later to determine relevance and comprehensiveness. J Patient Rep Outcomes 2023; 7:37. [PMID: 37022647 PMCID: PMC10079800 DOI: 10.1186/s41687-023-00558-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/07/2023] [Indexed: 04/07/2023] Open
Abstract
PURPOSE The BREAST-Q is the most used patient-reported outcome measure (PROM) in breast cancer surgery. The purposes of this study were to re-examine the content validity of BREAST-Q cancer modules (mastectomy, lumpectomy and reconstruction) and to determine the need for new scales. METHODS Interviews were conducted with women with breast cancer (Stage 0-4, any treatment), and were audio-recorded and transcribed verbatim. Deductive (based on original BREAST-Q conceptual framework) and inductive (new codes from the data) content analysis approaches were used to analyze the data. The number of codes that mapped to BREAST-Q were recorded. RESULTS Dataset included 3948 codes from 58 participants. Most of the breast (n = 659, 96%) and all psychosocial (n = 127, 100%), sexual (n = 179, 100%) and radiation-related (n = 79, 100%) codes mapped to BREAST-Q Satisfaction with Breast, Psychosocial Wellbeing, Sexual Wellbeing and Adverse Effects of Radiation scales, respectively. For the physical wellbeing codes (n = 939) for breast/chest and arm, 34% (n = 321) mapped to the Physical Wellbeing-Chest scale. Most of the abdomen codes (n = 311) mapped to Satisfaction with Abdomen (n = 90, 76%) and Physical Wellbeing-Abdomen (n = 171, 89%) scales. Codes that did not map (n = 697, 30%) covered breast sensation and lymphedema. Concerns related to fatigue, cancer worry, and work impact were most reported and did not map to BREAST-Q. CONCLUSION The BREAST-Q, which was developed using extensive patient input more than a decade ago, is still relevant. To ensure the BREAST-Q remains comprehensive, new scales for upper extremity lymphedema, breast sensation, fatigue, cancer worry, and work impact were developed.
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Affiliation(s)
- Manraj N Kaur
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA, 02115, USA.
| | - Sabrina Chan
- McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | - Louise Bordeleau
- Juravinski Cancer Center, Room 3-17, 699 Concession Street, Hamilton, ON, L8V 5C2, Canada
| | - Toni Zhong
- Toronto General Hospital, 8N-871, Norman Urquhart Wing, Toronto, ON, M5G 2C4, Canada
| | - Elena Tsangaris
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA, 02115, USA
| | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA, 02115, USA
| | - Stefan J Cano
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, England, GL50 3PR, UK
| | - Anne F Klassen
- McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
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21
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Devarakonda SK, Timman R, Bouvy PF, Oemrawsingh A, Apon I, Mureau MAM, Koppert LB, Kranenburg LW. Trends in emotional functioning and psychosocial wellbeing in breast cancer survivors: a prospective cohort study using patient-reported outcome measures. BMC Womens Health 2023; 23:153. [PMID: 36997924 PMCID: PMC10064532 DOI: 10.1186/s12905-023-02243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND A breast cancer diagnosis can threaten every aspect of a woman's wellbeing, including her mental health. With the growing number of breast cancer survivors, studies addressing mental health in this population are of increasing importance now more than ever. Therefore, the current study investigated trends in emotional functioning and psychosocial wellbeing of breast cancer survivors, and the demographic and treatment characteristics that may influence these trends. METHODS Prospectively collected data of women treated for breast cancer at the Erasmus MC were analyzed in this study using a cohort study design. Emotional functioning was measured using the EORTC-QLQ-C30, while psychosocial wellbeing was measured using the BREAST-Q. Type of surgery, age, family status and employment status of study participants were retrieved, and multilevel analyses were performed to identify trends in emotional functioning and psychosocial wellbeing and to determine the relationship between aforementioned characteristics and these outcomes. RESULTS Three hundred thirty-four cancer survivors were analyzed. Psychosocial wellbeing declined, but emotional functioning showed a steady improvement over time. Women who underwent breast reconstruction showed a steeper increase in their emotional functioning, and women with no partner or children showed a marginal decline in psychosocial wellbeing between baseline and 12 months after surgery. CONCLUSIONS These findings can be utilized by healthcare teams to identify breast cancer patients at risk for emotional problems and to provide adequate psychological support to those women who need help dealing with their emotions and self-concept in order to optimize clinical treatment.
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Affiliation(s)
- Sri K Devarakonda
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Reinier Timman
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Paul F Bouvy
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Arvind Oemrawsingh
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Inge Apon
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
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22
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Cogliandro A, Salzillo R, De Bernardis R, Loria FS, Petrucci V, Barone M, Tenna S, Cagli B, Persichetti P. Prepectoral Versus Subpectoral Direct-to-Implant Breast Reconstruction: Evaluation of Patient's Quality of Life and Satisfaction with BREAST-Q. Aesthetic Plast Surg 2023:10.1007/s00266-023-03316-z. [PMID: 36944866 DOI: 10.1007/s00266-023-03316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/26/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Over the years, plastic surgery has acquired a central role in the integrated treatment of breast cancer. Direct-to-implant (DTI) reconstruction using the prepectoral approach has emerged as an alternative to reconstruction using the subpectoral technique to overcome the complications arising from this type of surgery resulting as a consequence of muscle elevation. The satisfaction and quality of life of patients undergoing DTI breast reconstruction were evaluated using the BREAST-Q questionnaire, comparing the prepectoral and the subpectoral technique. METHODS A single-center cross-sectional study on patients who underwent mastectomy and DTI breast reconstruction at our institution between 2013 and 2021 was conducted. Eighty-one patients were included and mainly divided into two groups based on the surgical procedure: 52 patients undergoing a subpectoral breast reconstruction approach and 29 patients receiving a prepectoral breast reconstruction. In order to assess the quality of life, the postoperative BREAST-Q module was administered electronically to the enrolled patients. RESULTS Higher scores in BREAST-Q domains were recorded from patients who underwent mastectomy and breast reconstruction with prepectoral technique: psychosocial well-being (P<0.0085), sexual well-being (P<0.0120), physical well-being: lymphoedema (P<0.0001) and satisfaction with information received (P<0.0045). There were further statistically significant differences between the two groups with regard to postoperative complications (p<0.0465) and the need for reoperation (p<0.0275). CONCLUSIONS Patients who underwent DTI breast reconstruction with prepectoral technique were more satisfied in terms of psychosocial, sexual and also physical well-being. These patients also had statistically lower complications and reoperations compared to patients who received breast reconstruction with the subpectoral technique. LEVEL OF EVIDENCE IV This journal requires that authors 38 assign a level of evidence to each article. For a full 39 description of these Evidence-Based Medicine ratings, 40 please refer to the Table of Contents or the online 41 Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Annalisa Cogliandro
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
| | - Rosa Salzillo
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Riccardo De Bernardis
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Francesco Saverio Loria
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Valeria Petrucci
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Mauro Barone
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
| | - Stefania Tenna
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Barbara Cagli
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
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23
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Shunnmugam B, Islam T, Sinnadurai S, Seng Hui C, Mee Hong S, Chinna K, Aishah Mohd Taib N. Reliability and Validity of the Malay BREAST-Q in Women Undergoing Breast Cancer Surgery in Malaysia. Asia Pac J Public Health 2023; 35:129-135. [PMID: 37171249 DOI: 10.1177/10105395231163345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study aims to translate the BREAST-Q into Malay and validate it in breast cancer patients undergoing surgery. The English BREAST-Q was translated to Malay using the back-translation method. A total of 144 newly diagnosed breast cancer patients were sampled conveniently between December 2015 and November 2016. Test-retest was done after two to three weeks. Data were analyzed using SPSS and AMOS software. Content experts agreed the items in the Malay BREAST-Q were measuring the constructs appropriately. Internal consistencies were good for all items in each subscale (Cronbach's alpha = 0.83-0.95). The highest inter-item correlation for each item with at least one other item in the construct ranged from 0.47 to 0.90. The lowest corrected item-total correlation values ranged from 0.47 to 0.72. The test-retest analysis showed good reproducibility (intraclass correlation coefficient = 0.71-0.98). In exploratory factor analysis, the Kaiser-Meyer-Olkin values were excellent in all four subscales (0.76, 0.92, 0.91, and 0.86). For all subscales, the number of factors extracted cumulatively explained more than 50% of the variance. The Malay BREAST-Q demonstrated good reliability, face validity, content validity, and construct validity.
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Affiliation(s)
- Bairave Shunnmugam
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tania Islam
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siamala Sinnadurai
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chua Seng Hui
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - See Mee Hong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health & Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Cancer Research Institute, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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24
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Huberts AS, Clarijs ME, Pastoor H, van Rosmalen M, Koppert LB. Sexual well-being in patients with early-stage breast cancer at 1- and 2-year follow-up. J Sex Med 2023; 20:507-514. [PMID: 36790026 DOI: 10.1093/jsxmed/qdad007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Sexual well-being (SWB) is an important aspect of overall quality of life and should therefore be considered when measuring the effect of breast cancer on daily life. AIM To identify positive and negative predictive factors associated with change in SWB 1 year after diagnosis (T12; hereafter, ∆SWB) and whether SWB changes the year after. METHODS All data were derived from an online patient-reported outcome measure that included patients aged >18 years who were treated for breast cancer between October 2015 and March 2022 at the Erasmus University Medical Center. Multivariable linear regression was used to analyze the association between demographic- and disease-specific variables and change in SWB between time of diagnoses (T0) and one year after (T12) (∆SWB). For defining the clinical relevance of ∆SWB, patients were divided into 3 groups based on their SWB score at T12: decreased, stable, and improved. Wilcoxon signed rank test was used to test the difference in SWB between T12 and T24 (2 years after diagnosis) in all 3 groups. OUTCOMES Outcomes included the associations between demographic- and disease-specific variables and ∆SWB (T0 vs T12) and change in SWB the year after (T12 vs T24). RESULTS An overall 204 patients were included, with a mean age of 51.7 years (SD, 12.8) and a mean SWB score of 64.3 (SD, 20.9) at T0. Body mass index >30 kg/m2 at T0 had a significant negative association (β = -8.369, P = .019) with ∆SWB. Reconstruction (β = 20.136, P < .001) and mastectomy (β = 11.157, P < .001) had a significant positive association with ∆SWB vs lumpectomy. Change in psychological well-being had a significant positive relation to ∆SWB (β = 0.349, P < .001). Patients with decreased SWB at T12 did not improve the year after (P = .376). CLINICAL IMPLICATIONS By identifying the variables that are associated with decreased SWB during the trajectory of breast cancer treatment and by defining the clinical relevance of decreased SWB, patient groups can be targeted and offered extra support. STRENGTHS AND LIMITATIONS This study is one of the first to analyze the development of SWB, instead of sexual function, over time in patients with breast cancer, and it uses data over a longer period. However, only one-third of the patients responded to the SWB domains at both time points. CONCLUSION Type of operation, body mass index >30, and change in psychological well-being were associated with ∆SWB. Patients with decreased SWB 1 year after diagnosis tended not to improve or normalize the year after, indicating that intervention is needed to restore SWB in this specific group.
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Affiliation(s)
- Anouk S Huberts
- Department of Quality and Patient Care, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
| | - Marloes E Clarijs
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
| | - Hester Pastoor
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
| | - Mandy van Rosmalen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
| | - Linetta B Koppert
- Department of Quality and Patient Care, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands.,Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands
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25
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Crittenden TA, Watson DI, Ratcliffe J, Dean NR. Long-term outcomes of breast reduction surgery: A prospective cohort study. J Plast Reconstr Aesthet Surg 2023; 79:58-67. [PMID: 36868173 DOI: 10.1016/j.bjps.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Breast reduction surgery has been shown to be the most effective treatment for symptomatic breast hypertrophy in women. However, existing studies have been limited to a relatively short-term follow-up. This study aimed to assess the long-term outcomes following breast reduction surgery. METHODS This is a prospective cohort study of women aged 18 years and above who underwent breast reduction surgery over a 12-year period. Participants completed a series of patient-reported outcome measures, including the Short Form-36 (SF-36), BREAST-Q reduction module, Multidimensional Body-Self Relations Questionnaire (MBSRQ), and study-specific questions preoperatively, 12 months postoperatively, and at a long-term follow-up of up to 12 years postoperatively. RESULTS Long-term outcome data were obtained from 103 participants. The median follow-up time following surgery was 6.0 years, range 3-12 years. The mean SF-36 scores remained stable and significantly higher than baseline over time, with no significant differences found in all eight subscales or summary scales. BREAST-Q scores remained significantly higher than baseline in all four scales. MBSRQ scores for appearance evaluation, health evaluation, and body areas satisfaction score remained significantly higher than scores reported preoperatively; in contrast, scores for appearance and health orientation and self-classified weight were significantly lower. Compared with normative data, long-term outcome scores remained stable and at levels equivalent or beyond population norms. CONCLUSIONS This study demonstrated that patients continue to report a high level of satisfaction and improved health-related quality of life in the longer term following breast reduction surgery.
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Xia TY, Scomacao I, Duraes E, Cakmakoglu C, Schwarz G. Aesthetic, Quality-of-Life, and Clinical Outcomes after Inferior Pedicle Oncoplastic Reduction Mammoplasty. Aesthetic Plast Surg 2023. [PMID: 36735002 DOI: 10.1007/s00266-023-03257-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Oncoplastic breast surgery is more likely to achieve superior aesthetic outcomes compared to lumpectomy alone. Oncoplastic reduction mammoplasty (ORM) is a volume displacement oncoplastic technique that combines lumpectomy and reduction mammoplasty. Data on aesthetic and quality-of-life (QoL) outcomes after ORM are scarce in the literature. Based on a literature review, this present study reports outcomes on the largest group of ORM patients to date. METHODS A retrospective review was conducted of all patients who underwent ORM between 2011 and 2018 at a tertiary care centre. Patients were excluded if no pedicle information was available or did not undergo post-operative radiotherapy. All patients with available post-operative photographs were aesthetically evaluated by four blinded, independent investigators blinded based on breast symmetry, nipple symmetry, and overall appearance. The BREAST-Q (breast conserving module) was used to assess QoL outcomes. RESULTS Two-hundred-and-sixteen consecutive patients (223 breasts) were included. Macromastia (cup size D or higher) was present in 173 patients (80.1%). Inferior pedicle ORM was utilized in 179 (80.3%) breasts. Eighty-eight patients (40.7%) were aesthetically evaluated, of whom 69 patients (78.4%) had "good", "very good", or "excellent" grades in all aesthetic categories. Seventy-five patients (85.2%) had "good" or better grades in overall appearance. Preoperative ptosis grade, cup size, presence of post-operative complications, and breast specimen weight had no significant correlations with aesthetic grades. Inferior pedicle ORM was associated with a higher "satisfaction with breast" Q-score (p=0.017) compared to other pedicle approaches. CONCLUSION Inferior pedicle ORM achieves objectively excellent aesthetic outcomes and high patient satisfaction with the reconstruction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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27
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Kolberg HC, Niesing H, Vaidya JS, Akpolat-Basci L, Maguz A, Hoffmann O, Loevey G, Stephanou M, Kolberg-Liedtke C. Breast Conserving Surgery in Combination With Targeted Intraoperative Radiotherapy Compared to Mastectomy for In-breast-tumor-recurrence. Anticancer Res 2023; 43:733-739. [PMID: 36697057 DOI: 10.21873/anticanres.16212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIM Mastectomy is the standard treatment of in-breast-recurrence of breast cancer after breast conserving surgery (BCS) and external beam radiation therapy (EBRT). In selected cases, it is possible to preserve the breast if targeted intraoperative radiotherapy (TARGIT-IORT) can be given during the second lumpectomy. This is a comparative analysis of overall survival and quality of life (QoL). PATIENTS AND METHODS Patients in our database with in-breast-recurrence and either mastectomy or BCS and TARGIT-IORT were included. Identified patients were offered participation in a prospective QoL-analysis using the BREAST-Q questionnaire. The cohorts were compared for confounding parameters, overall survival, and QoL. RESULTS Thirty-six patients treated for in-breast-recurrence were included, 21 had received a mastectomy and 16 patients had received BCS with TARGIT-IORT. Mean follow-up was 12.8 years since primary diagnosis and 4.2 years since recurrence. Both groups were balanced regarding prognostic parameters. Overall survival was numerically longer for BCS and TARGIT-IORT, but the numbers were too small for formal statistical analysis. No patient had further in-breast-recurrence. Psychosocial and sexual wellbeing did not differ between both groups. Physical wellbeing was significantly superior for those whose breast could be preserved (p-value=0.021). Patient-reported incidence and severity of lymphedema of the arm was significantly worse in the mastectomy group (p=0.007). CONCLUSION Preserving the breast by use of TARGIT-IORT was safe with no re-recurrence and no detriment to overall survival in our analysis and led to a statistically significant improvement in physical wellbeing and incidence of lymphedema. These data should increase the confidence in offering breast preservation after in-breast-recurrence of breast cancer.
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Affiliation(s)
- Hans-Christian Kolberg
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany; .,Phaon Scientific GmbH, Wiesbaden, Germany
| | - Helena Niesing
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
| | - Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, London, U.K
| | - Leyla Akpolat-Basci
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
| | - Abdrhman Maguz
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
| | - Oliver Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | | | - Miltiades Stephanou
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
| | - Cornelia Kolberg-Liedtke
- Phaon Scientific GmbH, Wiesbaden, Germany.,Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
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28
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Riggio E, Alfieri S, Toffoli E, Borreani C. A descriptive comparison of satisfaction and well-being between expander-based and direct-to-implant breast reconstruction after Nipple-Sparing Mastectomy. Aesthetic Plast Surg 2023; 47:30-39. [PMID: 36018329 DOI: 10.1007/s00266-022-03061-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The literature that has explored differences between direct-to-implant (DTI) and expander-based (EB) breast reconstruction has mainly focused on complications, with results not always unambiguous. Moreover, there are limited data 1) comparing DTI and EB breast reconstruction after nipple-sparing mastectomy (NSM) and 2) from the patient's perspective. AIM The aim of this study was to compare satisfaction and well-being in patients undergoing DTI and EB reconstruction after NSM in a Comprehensive Cancer Center, exploring what factors can be related to satisfaction and well-being. METHOD The study design is monocentric, observational and retrospective. The participants completed an online questionnaire containing the Breast-Q and some socio-demographic variables (year of birth, level of education, civil status). Clinical information was obtained from the institutional database. Surgical techniques in the two branches of NSM were similar: all skin incisions, lateral to the areola; all implants, subpectoral (EB: conventionally submuscular; DTI: dual-plane pocket); all without synthetic mesh or acellular tissue matrix. RESULTS A total of 120 patients (45% with EB and 55% with DTI) completed the questionnaire. We found that there are no differences between EB and DTI concerning the satisfaction and well-being of NSM patients, except for satisfaction with information, which is greater in the DTI group. In EB patients, no variables among those explored are related to satisfaction and well-being. In DTI patients, level of education is positive related to satisfaction with implants and physical well-being, Tumor-Node-Metastasis (TNM) and body mass index (BMI) are negative related to satisfaction with information and TNM also with satisfaction for plastic surgery. CONCLUSION EB and DTI do not differ in terms of patient well-being, but EB requires a more careful counselling by the surgeon. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Egidio Riggio
- Unit of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Alfieri
- Clinical Psychology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Elisa Toffoli
- Unit of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Hassan AM, Ketheeswaran S, Adesoye T, Shah SA, Cox SE, Kapur SK, Checka CM, Offodile AC 2nd. Association between patient-surgeon race and gender concordance and patient-reported outcomes following breast cancer surgery. Breast Cancer Res Treat 2023; 198:167-75. [PMID: 36622543 DOI: 10.1007/s10549-022-06858-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Surgeon- and patient-related factors have been shown to influence patient experiences, quality of life (QoL), and surgical outcomes. We examined the association between patient-surgeon race and gender concordance with QoL after breast reconstruction. METHODS We conducted a retrospective cross-sectional analysis of patients who underwent lumpectomy or mastectomy followed by breast reconstruction over a 3-year period. We created the following categories with respect to the race and gender of a patient-surgeon triad: no, intermediate, and perfect concordance. Multivariable regression was used to correlate postoperative global (SF-12) and condition-specific (BREAST-Q) QoL performance with patient-level covariates, gender and race concordance. RESULTS We identified 375 patients with a mean (± SD) age of 57.6 ± 11.9 years, median (IQR) body mass index of 27.5 (24.0, 32.0), and median morbidity burden of 3 (2, 4). The majority of encounters were of intermediate concordance for gender (70%) and race (52%). Compared with gender-discordant triads, intermediate gender concordance was associated with higher SF-Mental scores (β, 2.60; 95% CI, 0.21-4.99, p = 0.003). Perfect race concordance (35% of encounters) was associated with significantly higher adjusted SF-Physical scores (β, 2.14; 95% CI, 0.50-4.22, p = 0.045) than the race-discordant group. There were no significant associations observed between race or gender concordance and BREAST-Q performance. CONCLUSION Race-concordant relationships following breast cancer surgery were more likely to have improved global QoL. Perfect gender concordance was not associated with variation in QoL outcomes. Policy-level interventions are needed to facilitate personalized care and optimize breast cancer surgery outcomes.
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Lembo F, Cecchino LR, Parisi D, Portincasa A. Immediate Breast Reconstruction in Skin-Reducing Mastectomy with Prepectoral Polyuretane (Pu) Implant Covered with an Autologous Dermo-Adipose Flap. Aesthetic Plast Surg 2023:10.1007/s00266-022-03240-8. [PMID: 36631603 DOI: 10.1007/s00266-022-03240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of this study was to present our new technique of immediate breast reconstruction with prepectoral Polyuretane (PU) Implants, covered with an autologous dermo-adipose flap, in skin-reducing mastectomy both for risk-reducing (prophylactic mastectomy) and therapeutic cases. METHODS We performed a single-center, retrospective review of 21 patients (mean age 47 years), undergone skin-reducing mastectomy and immediate breast reconstruction with prepectoral Polyuretane (PU) Implants, covered with an autologous dermo-adipose flap, un the period January 2018-June 2021. All procedures were performed by the same surgeon. RESULTS A total of 36 skin-reducing mastectomies (6 curative, 15 prophylactic) with one-stage prepectoral PU foam-coated implant and autologous dermo-adipose flap reconstruction were performed. All postoperative complications were collected. Quality of life (QoL) and satisfaction with reconstruction were evaluated through the BREAST-Q questionnaire, administered preoperatively and at 12 months after surgery. Independent Student's t tests were used to compare means of continuous variables and Chi-square test was used for ordinal variables. A p-value ≤0.05 was considered statistically significant. Uni- and multiple linear regression analyses were used to confirm all results. Out of 21 patients, we observed one small wound dehiscence and one partial Nipple-Areola Complex (NAC) necrosis. All cases of minor complications were managed conservatively and did not affect the quality of the final outcome. No implant loss was observed. No significant severe capsular contracture (grade III or IV) was detected at follow-up. Overall satisfaction with breasts, psychosocial, physical and sexual well-being all significantly increased, analyzing BRAST-Q data. Statistical analysis showed a significant influence of diabetes on the risk of complications. CONCLUSIONS Our experience suggests that the procedure described is effective, feasible and cost-effective. It is easier to perform compared to similar and more demanding procedure, reduces operative time, and minimizes complications related to manipulation of the pectoralis major muscle, while also contributing to the containment of costs. Moreover, it appears to be oncologically safe, provides good esthetic results with low postoperative complication rate and leads to high level of patients' satisfaction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Fedele Lembo
- Department of Plastic and Reconstructive Surgery, Foggia Medical School, University of Foggia, via Pinto, 71121, Foggia, Italy.
| | - Liberato Roberto Cecchino
- Department of Plastic and Reconstructive Surgery, Foggia Medical School, University of Foggia, via Pinto, 71121, Foggia, Italy
| | - Domenico Parisi
- Department of Plastic and Reconstructive Surgery, Foggia Medical School, University of Foggia, via Pinto, 71121, Foggia, Italy
| | - Aurelio Portincasa
- Department of Plastic and Reconstructive Surgery, Foggia Medical School, University of Foggia, via Pinto, 71121, Foggia, Italy
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Nelson JA, Chu JJ, Dabic S, Kenworthy EO, Shamsunder MG, McCarthy CM, Mehrara BJ, Pusic AL. Moving towards patient-reported outcomes in routine clinical practice: implementation lessons from the BREAST-Q. Qual Life Res 2023; 32:115-125. [PMID: 35972615 PMCID: PMC9380681 DOI: 10.1007/s11136-022-03213-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Longitudinal, routine utilization of patient-reported outcome measures (PROMs) in clinical care has been challenging. The purpose of this study is to describe a quality improvement initiative to improve patient engagement with the BREAST-Q, a gold-standard PROM for breast reconstruction. METHODS In 2011, we implemented the BREAST-Q as part of routine care. In 2018, we began a quality improvement initiative to increase BREAST-Q patient participation. The BREAST-Q was administered at every clinic visit via an institutional patient portal or an in-clinic tablet; digital dashboard technologies were used to improve workflow integration, real-time accountability, and immediate data availability at clinic visits. High clinical staff engagement was encouraged by assigning "BREAST-Q Champions." BREAST-Q completion data and patient characteristics were examined to understand non-response to the assessment. RESULTS Following quality improvement, the average annual BREAST-Q completion rate increased from 42.8% in 2011-2017 to 87.6% in 2019, the last full year of our study period. High completion rates were maintained January-July 2020; however, a significantly larger proportion of BREAST-Qs were completed at home in 2020 versus the same period in 2019 (49.7 vs. 38.8%, p < 0.001), potentially due to the COVID-19 pandemic. Compared with non-responders, responders were younger (49.7 vs. 52.2 years, p < 0.001), more likely to be white (76.9 vs. 73.6%, p < 0.001), and had private insurance (79.4 vs. 69.8%, p < 0.001). CONCLUSION Our quality improvement initiative successfully increased routine completion of the BREAST-Q. Similar implementation techniques may prove beneficial at other institutions interested in incorporating PROMs into routine care.
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Affiliation(s)
- Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 321 E 61st St,, New York, NY, 10065, USA.
| | - Jacqueline J Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 321 E 61st St,, New York, NY, 10065, USA
| | - Stefan Dabic
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 321 E 61st St,, New York, NY, 10065, USA
| | - Elizabeth O Kenworthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 321 E 61st St,, New York, NY, 10065, USA
| | - Meghana G Shamsunder
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 321 E 61st St,, New York, NY, 10065, USA
| | - Colleen M McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 321 E 61st St,, New York, NY, 10065, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 321 E 61st St,, New York, NY, 10065, USA
| | - Andrea L Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Tunå Butt S, Widmark-Jensen E, Meyer S, Hansson E. Swedish Normative Scores for the BREAST-Q Reduction/Mastopexy Module. Aesthetic Plast Surg 2023; 47:73-80. [PMID: 35920862 DOI: 10.1007/s00266-022-03025-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Norm values for patient reported outcomes, that is knowledge about how the general population of women rate their breast-related satisfaction and quality of life, are necessary to interpret the meaning of scores. The aims of this study were to create Swedish normative values for the BREAST-Q reduction/mastopexy module and to describe what healthy women are most satisfied/dissatisfied with regarding their breasts. METHODS A random sample of 400 women aged 18-80, currently living in Region Västra Götaland, were sent BREAST-Q reduction/mastopexy. Descriptive data are presented. RESULTS One hundred and forty-six women answered the questionnaire (36.5%). Mean total scores ranged from 48 to 78. No clear changes in scores could be seen with age and women with a high BMI seem to be less satisfied with their breasts. The participants were most satisfied with the appearance of the breasts when dressed, the appearance in the mirror dressed, the shape of the breasts with bra, and symmetry of size and most dissatisfied with appearance in the mirror naked and the shape of the breasts without a bra. Thirty to forty-five per cent of healthy women never or almost never feel sexually attractive. Among physical symptoms often described in breast hypertrophy, the most common among healthy women were lack of energy, pain in the neck, arms and shoulders, headache and difficulty performing intense physical activity. CONCLUSION The norms for BREAST-Q reduction/mastopexy add another piece to the puzzle to what constitutes normal breast satisfaction and how surgical outcomes can be evaluated. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Mansour K, Calder P, Trotter D, Mah E, Tasevski R, Chin-Lenn L, Yue B, Mann B, Skandarajah A. Patient-reported outcomes post prophylactic risk-reducing mastectomy: improved breast and psychosocial satisfaction yet poorer physical well-being. ANZ J Surg 2023; 93:251-256. [PMID: 36692298 DOI: 10.1111/ans.18277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Few studies have investigated patient-reported outcomes (PROs) for patients with high breast cancer risk undergoing elective risk reduction mastectomy and reconstruction. These patients incur operative risk in the absence of active cancer, which renders their treatment experience unique. This study aimed to identify longer-term quality of life (QoL) issues that persist in this patient cohort. METHODS A cross-sectional cohort study assessed PROs in 48 women with high breast cancer risk who attended the Royal Melbourne Hospital Risk Management Clinic, at least 12 months post-mastectomy and reconstruction, with surgery between 2011 and 2020, using the BREAST-Q© Likert surveys. The BREAST-Q© internationally validated QoL instrument scales survey data from 0 (worst) to 100 (best) in 14 domains addressing satisfaction and psychosocial issues. RESULTS There was higher overall breast and psychosocial satisfaction, with scores of 11 and four, respectively, yet lower chest, abdomen and sexual well-being scores with 14, three and four, respectively, in contrast to normative BREAST-Q© data from >1000 women without prior breast cancer or breast operations. High average scores >90 were found for patient satisfaction with surgical, medical and office staff. Twenty-one patients had an average score of 63 for satisfaction with breast implants, while 27 patients post-DIEP had average scores >72 for abdominal well-being, appearance and overall outcomes. Higher mean QoL outcomes were found with DIEP flap in all domains, compared with breast implant reconstruction. CONCLUSION QoL assessment with PROs 12 months post-risk reduction mastectomy and reconstruction demonstrated higher psychosocial well-being, yet highlights physical implications, with patients experiencing reduced chest, abdomen and sexual well-being, compared with normative BREAST-Q© control data. Higher mean QoL outcomes were found with DIEP flap compared with breast implant reconstruction. PROs studies can identify unmet needs and facilitate change in service provision.
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Affiliation(s)
- Kristy Mansour
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Patricia Calder
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dean Trotter
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Eldon Mah
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Robert Tasevski
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Laura Chin-Lenn
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Brian Yue
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Bruce Mann
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anita Skandarajah
- The Breast Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Plastics Surgery and Reconstruction Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Mason EJ, Di Leone A, Franco A, D'Archi S, Rianna C, Sanchez AM, Murando F, Accetta C, Scardina L, Terribile DA, Masetti R, Franceschini G. Oncoplastic Breast Surgery versus Conservative Mastectomy in the Management of Large Ductal Carcinoma In Situ (DCIS): Surgical, Oncological, and Patient-Reported Outcomes. Cancers (Basel) 2022; 14. [PMID: 36428718 DOI: 10.3390/cancers14225624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Oncoplastic level II breast-conserving surgery (OPS2) allows for wider excisions than standard breast-conserving surgery, but the literature on this technique in the treatment of DCIS is scarce. This study compares OPS2 to conservative mastectomy (CM) in patients undergoing surgery for large DCIS. The clinical, radiological, surgical, and post-operative data of 147 patients who underwent either CM or OPS2 for large DCIS between 2007 and 2021 were retrospectively reviewed. The surgical, oncological, and patient-reported outcomes (PRO) were analyzed and compared between the two groups. The surgical outcomes were similar, in terms of margin involvement (p = 0.211), complication rate (p = 0.827), and re-excision rate (p = 1). The rate of additional surgery for cosmetic optimization was significantly lower in the OPS2 group: only 1 (1.8%) patient required surgical adjustments versus 24 (26.4%) patients in the CM group (p < 0.001). The mean hospital stay was lower in the OPS2 group (p < 0.001). The oncological outcomes did not differ between the two groups (p = 0.662). The PRO analysis showed better outcomes in the OPS2 group, which achieved statistical significance in the sexual well-being module (p = 0.015). Skin sensitivity loss was also significantly lower in the OPS2 group (p < 0.001). When feasible, OPS2 should be considered in the treatment of large DCIS, as it is safe and shows high levels of patient satisfaction.
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Manivit C, Dannepond A, Brun JL, Pinsolle V, Casoli V, Charitansky H, Babin-Commeny J. [Satisfaction after risk reducing mastectomy related to breast reconstruction surgery in patient with hereditary genetic mutation]. Gynecol Obstet Fertil Senol 2022; 50:650-656. [PMID: 35777668 DOI: 10.1016/j.gofs.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Patients with very high risk of cancer mutation may decide to undergo prophylactic surgery in order to avoid heavy clinical and radiological monitoring. This is a promising and nonetheless risky surgery because it is a complicated procedure and highly mutilating. Our goal was to improve the practice of this prophylactic surgery, to do so we assessed a postoperative satisfaction survey to cancer-free patients who have undergone this procedure. MATERIAL Single-center, cross-sectional descriptive study. Assessment of the primary efficacy endpoint using the BREAST-Q questionnaire. These results were compared to a control group representative of our sample of patients, those data came from the scientific literature using a single-sample Student's test. Several multivariate analyzes were also carried out in order to study the influence of certain factors on the patient's satisfaction. RESULTS The averages obtained in the various questionnaires were 56.06/100 for "Satisfaction with breasts"; 66.94/100 for "Psychosocial well-being"; 50/100 for "Sexual well-being" and 59.22/100 for "Satisfaction with information". Postoperative satisfaction in our sample is comparable to the group control concerning the questionnaire "Satisfaction with breasts" (P=0.37) and "Psychosocial well-being" (P=0.18). Concerning the questionnaire "Sexual well-being" there is a significant statistical difference between our group and the control group (P=0.01). CONCLUSION The post-operative satisfaction of our operated patients seems to be proportionally similar to the general population who have not undergone breast surgery except on the question of the quality of sexual life. The various analyzes of our study also allowed us to highlight the importance of preoperative information for postoperative well-being.
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Affiliation(s)
- C Manivit
- Service de chirurgie gynécologique, CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - A Dannepond
- Service de chirurgie plastique, esthétique et reconstructrice du CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - J-L Brun
- Service de chirurgie gynécologique, CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - V Pinsolle
- Service de chirurgie plastique, esthétique et reconstructrice du CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - V Casoli
- Service de chirurgie plastique, esthétique et reconstructrice du CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - H Charitansky
- Service de chirurgie de l'Institut Bergonié, Institut Bergonié, 229, Cr de l'Argonne, 33000 Bordeaux, France
| | - J Babin-Commeny
- Service de chirurgie de l'Institut Bergonié, Institut Bergonié, 229, Cr de l'Argonne, 33000 Bordeaux, France
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Guan D, Mo Q, Zheng Y. Immediate prosthetic breast reconstruction after removal of the polyacrylamide hydrogel (PAAG) through a small areolar incision assisted with an endoscope. BMC Surg 2022; 22:332. [PMID: 36071418 PMCID: PMC9450310 DOI: 10.1186/s12893-022-01778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background To identify the feasibility, safety, cosmetic outcomes and patient satisfaction of immediate prosthetic breast reconstruction after removal of Polyacrylamide Hydrogel (PAAG) through a small areolar incision assisted with an endoscope. Methods This was a retrospective study. Medical records of 87 patients who underwent PAAG removal were reviewed retrospectively from February 2010 to December 2019. These patients were dichotomized based on whether they accepted immediate prosthetic breast reconstruction after PAAG removal or not. A comprehensive analysis on the data was conducted to observe the surgical results, cosmetic outcomes, health-related quality of life (HRQOL) and patient satisfaction. Results Sixty-two patients underwent PAAG removal through a small areolar incision assisted with an endoscope, while another 25 patients underwent further immediate prosthetic breast reconstruction after PAAG removal. All the patients recovered smoothly after operation. In the immediate breast reconstructed group, most of the breasts were natural in appearance, but one patient had mild nipple and breast asymmetry, and another had mild breast asymmetry. Three patients had PAAG residual, and one of them accepted fine needle aspiration. The cosmetic satisfaction rate was 88% and 92% by surgeons and patients, respectively. In the other group, seven patients suffered from PAAG residual, one patient suffered from postoperative bleeding, and five patients suffered from skin laxity. The BREAST-Q scores revealed that patients who accepted immediate breast reconstruction had significant better outcomes in psychosocial well-being (p = 0.030), satisfaction with breasts (p = 0.021), when compared to patients who only accepted PAAG removal, while similar in sexual well-being (p = 0.081), physical well-being chest (p = 0.124), and satisfaction with outcomes (p = 0.068), and satisfaction with care (p = 0.077). Conclusion Immediate prosthetic breast reconstruction after PAAG removal through a small areolar incision aided with an endoscope might be a viable and safe technique, with better psychosocial well-being and satisfaction with breasts.
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Affiliation(s)
- Dandan Guan
- General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Qiuping Mo
- General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Yajuan Zheng
- General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China.
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Tahmasebi S, Mohammadipour M, Ghoddusi Johari M, Shariat M, Akrami M, Zangouri V, Karami M, Talei A. Determination of Oncologic Outcomes, Satisfaction, and Psychosocial Well-being in Patients with Breast Cancer after Oncoplastic and Conventional Breast Conserving Surgery. World J Plast Surg 2022; 11:72-7. [PMID: 36694674 DOI: 10.52547/wjps.11.3.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Breast cancer is the most common cancer in women and surgery is necessary for its treatment. We aimed to determine the oncologic outcomes, satisfaction with breasts, and psychosocial well-being in the patients with breast cancer, after oncoplastic and conventional breast conserving surgery (BCS). Method The patients with breast cancer from Shahid Motahari Clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from December 2020 to December 2021 were allocated to two groups, one who had undergone BCS alone and the patients who had undergone oncoplastic BCS. For all the patients, demographic data, data about surgery, oncologic outcomes, wound complications, and BREAST-Q© questionnaire score were collected and compared between two groups. Result The mean age of the patients in the oncoplastic BCS and BCS group was 48.13±9.73 (median=48), and 50.01±8.47 (median=50) years, respectively. The mean score of psychosocial well-being was higher in the oncoplastic BCS group in comparison with BCS alone. (P-value< 0.0001). Also, the mean score of satisfaction with breast was higher among the oncoplastic BCS group in comparison with the BCS group (P-value< 0.0001). Conclusion Replacing traditional BCS with oncoplastic BCS does not adversely affect the oncologic results of surgery but improves the consequent psychosocial well-being and satisfaction in the patients.
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Nelson JA, Chu JJ, McCarthy CM, Stern CS, Shamsunder MG, Pusic AL, Mehrara BJ. BREAST-Q REACT: Clinical Reference Values for the BREAST-Q in Post-mastectomy Breast Reconstruction Patients. Ann Surg Oncol 2022; 29:5280-5293. [PMID: 35415816 PMCID: PMC10337694 DOI: 10.1245/s10434-022-11521-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The BREAST-Q is the most commonly used patient-reported outcome measure (PROM) for breast reconstruction research. However, clinical implementation of this PROM has been impeded by a lack of context for score interpretation. The aim of this study was to define reference values for the BREAST-Q at discrete timepoints following surgery, generating a tool for real-time score interpretation. METHODS BREAST-Q scores were prospectively obtained in women who underwent implant or autologous post-mastectomy breast reconstruction preoperatively and for 2 years following surgery at Memorial Sloan Kettering Cancer Center (MSK). Descriptive statistics were used to create reference values for BREAST-Q satisfaction and quality-of-life subscales. Reference values were externally validated by comparing patient characteristics and BREAST-Q scores between the MSK and the Mastectomy Reconstruction Outcomes Consortium (MROC) study cohorts. RESULTS Overall, 3268 MSK patients and 2814 MROC patients were included for analysis. When MSK and MROC cohorts were compared for validation, there were some statistical differences in BREAST-Q scores; however, most of these differences did not meet the minimal clinically important difference of 4 points. Reference values were used to create the BREAST-Q Real-time Engagement and Communication Tool (REACT). CONCLUSIONS Using a large cohort of patients, we have defined BREAST-Q reference values for post-mastectomy breast reconstruction patients for use in clinical practice. The BREAST-Q REACT will help breast reconstruction providers gauge patient wellbeing and satisfaction relative to the "average" breast reconstruction patient and determine which patients may benefit from additional intervention.
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Affiliation(s)
- Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jacqueline J Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Colleen M McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghana G Shamsunder
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Sala L, Bonomi S, Ciniselli CM, Verderio P, Pastori M, Maurichi A, Cortinovis U. Patient-reported outcome measurements in post-mastectomy implant-based breast reconstruction and radiotherapy: Analysis of BREAST-Q data. Tumori 2022:3008916221107715. [PMID: 35801836 DOI: 10.1177/03008916221107715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Breast reconstruction has become a standard of care in patients undergoing mastectomy, greatly improving their quality of life. An increasing number of patients-reported outcome measurements (PROMs) have been developed over the years to better analyze patients' subjective overall experience. BREAST-Q is the PROMs for breast surgery introduced in our practice to assess patients' experiences when undergoing implant-based breast reconstruction and radiotherapy along with the use of Peak Plasma Blade and acellular dermal matrix. METHODS The pre-operative version of the Reconstruction BREAST-Q was administered to all 88 patients enrolled between December 2017 and December 2018 in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano through person-to-person interviews, while the post-operative version was administered to the 75 patients who completed a 12-month follow-up (four patients died during one-year follow-up and nine patients had major complications). The survey areas highlighted were: satisfaction with breast, psychosocial well-being, physical well-being and sexual well-being. RESULTS From BREAST-Q questions regarding Satisfaction With The Appearance Of The Breast and Psychosocial Well-Being outcomes showed significant improvement from pre-operative data, as well as with Satisfaction With Overall Care, with the exception of Physical Well-Being Chest. CONCLUSIONS BREAST-Q allows the assessment of patients' perception, not only for surgical results, but also for the overall experience with surgeons and medical staff.The women enrolled in our study reported an overall good patient satisfaction in most of the analyzed fields.
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Affiliation(s)
- Laura Sala
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Stefano Bonomi
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori Milan, Italy
| | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori Milan, Italy
| | - Marta Pastori
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori Milan, Italy
| | - Andrea Maurichi
- Department of Melanoma Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Umberto Cortinovis
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Choi WJ, Song WJ, Kang SG. A Comparative Analysis of Patient Satisfaction and Cosmetic Outcomes after Breast Reconstruction through BREAST-Q and the Judgment of Medical Panels: Does it Reflect Well in Terms of Aesthetics in Korean Patients? Arch Plast Surg 2022; 49:488-493. [PMID: 35919544 PMCID: PMC9340164 DOI: 10.1055/s-0042-1744417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background
Currently, the BREAST-Q can effectively measure patient's satisfaction on the quality of life from the patient's perspective in relation to different type of breast reconstruction. However, evaluation of patient satisfaction and cosmetic outcomes in breast reconstruction may have potential to led bias.
Methods
To maximize the benefits of using BREAST-Q to evaluate clinical outcome, we performed comparative study focused on the correlation between postoperative BREAST-Q and cosmetic outcomes assessed by medical professionals. For the current analysis, we used three postoperative BREAST-Q scales (satisfaction with breast, psychosocial well-being, and sexual well-being). The Ten-Point Scale by Visser et al was applied to provide reproducible grading of the postoperative cosmetic outcomes of the breast. The system includes six subscales that measured overall aesthetic outcome, volume, shape, symmetry, scarring, and nipple-areolar complex. The photographic assessments were made by five medical professionals who were shown photographs on a computer screen in a random order. Obtained data were stored in Excel and evaluated by Spearman's correlations using SPSS Statistics.
Results
We enrolled 92 women in this study, 10 did not respond to all scales of postoperative BREAST-Q, the remaining 82 women had undergone breast reconstruction. The correlation between BREAST-Q score and aesthetic score measured by Ten-Point Scale for the three BREAST-Q scales all show positive values in Spearman's correlation coefficient.
Conclusion
A significant correlation without any bias observed was found between the patient's satisfaction measured by BREAST-Q after breast reconstruction and the medical expert's aesthetic evaluation.
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Affiliation(s)
- Woo Jung Choi
- Departments of Plastic and Reconstructive Surgery and College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Woo Jin Song
- Departments of Plastic and Reconstructive Surgery and College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Sang Gue Kang
- Departments of Plastic and Reconstructive Surgery and College of Medicine, Soonchunhyang University, Seoul, Korea
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La Padula S, Pensato R, D'Andrea F, de Gregorio L, Errico C, Rega U, Canta L, Pizza C, Roccaro G, Billon R, Dibra E, Meningaud JP, Hersant B. Assessment of Patient Satisfaction Using a New Augmented Reality Simulation Software for Breast Augmentation: A Prospective Study. J Clin Med 2022; 11. [PMID: 35743534 DOI: 10.3390/jcm11123464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Breast augmentation is one of the most frequently performed plastic surgery procedures. Providing patients with realistic 3D simulations of breast augmentation outcomes is becoming increasingly common. Until recently, such programs were expensive and required significant equipment, training, and office space. New simple user-friendly programs have been developed, but to date there remains a paucity of objective evidence comparing these 3D simulations with post-operative outcomes. The aim of this study is to assess the aesthetic similarity between a pre-operative 3D simulation generated using Arbrea breast simulation software and real post-operative outcomes, with a focus on patient satisfaction. Methods: The authors conducted a prospective study of patients requiring breast augmentation. Patients were asked to assess how realistic the simulation was compared to the one-year post-operative result using the authors’ grading scale for breast augmentation simulation assessment. Patient satisfaction with the simulations was assessed using a satisfaction visual analogue scale (VAS) ranging from 0 (not at all satisfied) to 10 (very satisfied). Patient satisfaction with the surgical outcome was assessed using the BREAST-Q Augmentation Module. Results: All patients were satisfied with the simulations and with the attained breast volume, with a mean VAS score of 8.2 ± 1.2. The mean simulation time took 90 s on average. The differences between the pre-operative and one-year post-operative values of the three BREAST-Q assessments were found to be statistically significant (p < 0.001). Conclusions: Three-dimensional simulation is becoming increasingly common in pre-operative planning for breast augmentation. The present study aimed to assess the degree of similarity of three-dimensional simulations generated using Arbrea Breast Software and found that the use of the software provided a very satisfying representation for patients undergoing breast augmentation. However, we recommend informing patients that only the volume simulation is extremely accurate. On the other hand, it is necessary to not guarantee an absolute correspondence regarding the breast shape between the simulation and the post-operative result.
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Tomita S, Matsunaga N, Fujita Y, de Kerckhove M, Fujii M, Honda Y, Tokisawa H, Aruga T, Terao Y. Safety evaluation of immediate breast reconstruction for locally advanced breast cancer in Japanese patients. J Plast Reconstr Aesthet Surg 2022; 75:2526-2534. [PMID: 35599220 DOI: 10.1016/j.bjps.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/27/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND While breast reconstruction often improves the quality of life of patients with locally advanced breast cancer, there is still no consensus on its safety. This retrospective report aimed to verify the safety of immediate breast reconstruction for locally advanced breast cancer. METHODS We retrospectively analyzed 500 breast cancer surgeries performed between January 2005 and December 2019 at our hospital, including 120 immediate breast reconstructions. The following five items were analyzed: the patients' choice of reconstruction method, rate of chemotherapy and radiotherapy, surgical margin positivity rate, complications associated with surgery, overall survival rate, and breast cancer-free survival rate. RESULTS Sixty-three of the 120 patients underwent autologous breast reconstruction. Of those who underwent reconstruction surgery, 95.8% received chemotherapy and 78.3% underwent post-mastectomy radiation therapy. Reconstruction failed in 8 cases with tissue expander and in 1 case with free TRAM flap. Breast reconstruction surgery was not a factor in delaying adjuvant therapy, but complications requiring intervention tended to increase the duration of adjuvant therapy. There was no statistically significant difference in the rate of surgical margin positivity, overall survival rate, or breast cancer-free survival rate. CONCLUSIONS Although complications associated with reconstructive surgery occurred, appropriate intervention prevented delays in breast cancer treatment, and the complications did not negatively affect the overall or breast cancer-free survival rates. Our study found no evidence to avoid primary breast reconstruction in patients with locally advanced breast cancer.
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Affiliation(s)
- Shoichi Tomita
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Noriko Matsunaga
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yoshihiko Fujita
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Maiko de Kerckhove
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Miwako Fujii
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yayoi Honda
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Hiromi Tokisawa
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tomoyuki Aruga
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yasunobu Terao
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Santanelli Di Pompeo F, Barone M, Salzillo R, Cogliandro A, Brunetti B, Ciarrocchi S, Alessandri Bonetti M, Tenna S, Sorotos M, Persichetti P. Predictive Factors of Satisfaction Following Breast Reconstruction: Do they Influence Patients? Aesthetic Plast Surg 2022; 46:610-618. [PMID: 34559281 DOI: 10.1007/s00266-021-02584-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/06/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION This study aims to analyze whether there is any patient- or treatment-related factor that can influence patients' body perception after mastectomy and autologous or implant-based breast reconstruction. MATERIALS AND METHODS This retrospective cohort study included patients who underwent immediate implant-based or DIEP flap breast reconstruction. Predictive factors analyzed included chemotherapy, radiotherapy, hormone therapy, body mass index, age, type of mastectomy, and follow-up length. The BREAST-Q was administered postoperatively almost 2 years from the last surgical procedure. Mean BREAST-Q scores were reported for the overall cohort and by modality for the postoperative period. A linear regression model was applied to all BREAST-Q scores with all predictor factors. RESULTS In total, 325 patients were enrolled in this study (133 DIEP flap and 192 implant-based reconstructions). The DIEP flap reconstruction group with a previous nipple sparing mastectomy showed the highest scores. Patients with a longer follow-up were less satisfied than the ones with a shorter follow-up, which could be considered as an assessment of the outcome. No significant difference was reported between patients who underwent radiotherapy, chemotherapy or hormone therapy and those who did not. Furthermore, age and BMI had no influence on patient satisfaction. CONCLUSION This study is the first that groups a large number of patients and analyzes predictive factors of long-term satisfaction of patients undergoing breast reconstruction. This can be regarded as a pilot study to raise the awareness of everyone's clinical practice to predict the attitude that patients have after surgery and to prepare them in the best possible way. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com .
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Affiliation(s)
- Fabio Santanelli Di Pompeo
- Chair of Plastic Surgery, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Mauro Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy.
- Research group ``To be and to appear: Objective indication to Plastic Surgery'' of Campus Bio-Medico University in Rome, Rome, Italy.
- Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Rosa Salzillo
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Annalisa Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
- Research group ``To be and to appear: Objective indication to Plastic Surgery'' of Campus Bio-Medico University in Rome, Rome, Italy
| | - Beniamino Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Silvia Ciarrocchi
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, I.R.C.C.S. Istituto Galezzi, University of Milan, Milan, Italy
| | - Stefania Tenna
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
- Research group ``To be and to appear: Objective indication to Plastic Surgery'' of Campus Bio-Medico University in Rome, Rome, Italy
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Davis MJ, Roy MG, Monson LA. Analysis of adolescent patient satisfaction and well-being following reduction mammaplasty using the BREAST-Q survey. J Pediatr Surg 2022; 57:538-43. [PMID: 34289933 DOI: 10.1016/j.jpedsurg.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND While functional breast reduction surgery has been shown to lead to increased quality of life in adult patients, the effects of this operation has not been investigated as thoroughly in adolescent patients. This study uses the BREAST-Q, a validated, surgery-specific questionnaire, to measure changes in adolescent patient well-being and satisfaction following reduction mammaplasty. METHODS All patients presenting for breast reduction consultation between February and December 2016 were asked to complete the BREAST-Q. Post-operative surveys were completed at three-month follow up. A matched control cohort was established using patients who completed a pre-operative survey and were deemed appropriate surgical candidates, but then were denied by insurance and did not undergo surgery. RESULTS Of the 28 adolescent patients who presented for breast reduction consultation, 15 met inclusion criteria; 11 patients underwent reduction mammaplasty, and 4 patients were included in the control cohort. When these groups were compared, statistically significant improvements were observed in all BREAST-Q categories except for sexual well-being. Overall patient satisfaction correlated most highly to satisfaction with information. CONCLUSIONS This study examines quality of life outcomes in adolescent breast reduction patients using the BREAST-Q survey. Our findings indicate that adolescent patients have an improved quality of life following breast reduction, but that their satisfaction stems from different sources from those of adult patients. Further characterization of outcomes specific to young patients with surgically managed symptomatic macromastia will increase the practice of tailored, evidence-based medicine for adolescent patients. LEVEL OF EVIDENCE Treatment Study, Level III.
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Persichetti P, Barone M, Salzillo R, Cogliandro A, Brunetti B, Ciarrocchi S, Alessandri Bonetti M, Tenna S, Sorotos M, Santanelli Di Pompeo F. Impact on Patient's Appearance Perception of Autologous and Implant Based Breast Reconstruction Following Mastectomy Using BREAST-Q. Aesthetic Plast Surg 2022; 46:1153-1163. [PMID: 35229192 PMCID: PMC9411234 DOI: 10.1007/s00266-022-02776-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
Introduction The purpose of this study is to determine if there is a better quality of life with one of the two techniques and if the results are in line with those already present in the literature. The hypothesis from which we started is to demonstrate that cancer patients who undergo a deep inferior epigastric perforator flap (DIEP) breast reconstruction surgery are more satisfied and have a higher level of quality of life compared to those subjected to an intervention of reconstruction with prosthesis. Materials and Methods All patients undergoing reconstruction from January 2010 to July 2018 were eligible for inclusion. This is a retrospective cohort study carried out using the patients of two plastic surgery departments who have undergone monolateral or bilateral implant-based or DIEP flap breast reconstruction. We administered BREAST-Q questionnaire electronically almost 2 year after surgery. Patients were divided into two groups: implant-based and autologous breast reconstruction with DIEP flaps. Baseline demographics and patient characteristics were analyzed using a Students t-test (continuous variables) or Chi-square/Fisher’s exact test (categorical variables). Mean standard deviation BREAST-Q scores were reported for the overall cohort and by modality for the postoperative period. The linear regression model was applied to all BREAST-Q score with all predictor factors. Results Of the 1125 patients involved, only 325 met the inclusion criteria and were enrolled in this study; specifically, 133 (41%) DIEP and 192 (59%) prosthetic reconstructions. We summarized the results of the principal scales of BREAST-Q module: satisfaction with breast, psychosocial well-being, satisfaction with outcome, and sexual well-being in which the autologous group was always more satisfied. We reported results of all linear regression models with higher values for the DIEP group independently from predictors. Conclusion This is the first study performed on the Italian population that compares autologous surgical techniques with the implantation of breast implants. In this population, DIEP is considered the technique that leads to the highest satisfaction in all BREAST-Q scores. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
- Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy
| | - Mauro Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
- Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rosa Salzillo
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Annalisa Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Beniamino Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Silvia Ciarrocchi
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Milan, Italy
| | - Stefania Tenna
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
- Plastic and Reconstructive Surgery Unit, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Fabio Santanelli Di Pompeo
- Faculty of Medicine and Psychology, U.O.D. Chirurgia Plastica, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
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Ching AH, Lim K, Sze PW, Ooi A. Quality of life, pain of prepectoral and subpectoral implant-based breast reconstruction with a discussion on cost: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2550-2560. [PMID: 35393263 DOI: 10.1016/j.bjps.2022.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/12/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Prepectoral implant-based breast reconstruction (PIBR) has regained popularity, despite decades-long preference for subpectoral implant placement. This paper aims to compare patient-reported outcomes (PRO) between prepectoral and subpectoral approaches to implant-based breast reconstruction (IBBR). The primary PRO was with the BREAST-Q, and postoperative pain scores, while the secondary outcomes were complication rates. METHODS A comprehensive literature search of the PubMed library was performed. All studies on patients undergoing IBBR after mastectomy that compared prepectoral to subpectoral placement and PROM or postoperative pain were included. RESULTS A total of 3789 unique studies of which 7 publications with 216 and 332 patients who received prepectoral and subpectoral implants, respectively, were included for meta-analysis. Patients with prepectoral implant placement had significantly higher satisfaction with the outcome (p = 0.03) and psychosocial well-being (p = 0.03) module scores. The pain was lower in patients with prepectoral implants on postoperative day 1 (p<0.01) and day 7 (p<0.01). The subgroup analysis of prepectoral breast implants showed that complete acellular dermal matrix coverage had lower rates of wound dehiscence (p<0.0001), but there were no significant differences in complications between one-stage and two-stage procedures. CONCLUSION Overall, patients with prepectoral implants reported higher BREAST-Q scores and lower postoperative pain and lower complications rates than patients with subpectoral implants. In appropriately selected patients, prepectoral implant placement with ADM coverage, be it the primary placement of an implant or placement of a tissue expander before definitive implant placement, should be the modality of choice in patients who choose IBBR. Further research should focus on patient selection, strategies to reduce cost and cost-benefit analysis of PIBR.
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Affiliation(s)
- Ann Hui Ching
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kimberley Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pek Wan Sze
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Adrian Ooi
- Polaris Plastic & Reconstructive surgery, Singapore.
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Seth I, Seth N, Bulloch G, Rozen WM, Hunter-Smith DJ. Systematic Review of Breast-Q: A Tool to Evaluate Post-Mastectomy Breast Reconstruction. Breast Cancer (Dove Med Press) 2021; 13:711-724. [PMID: 34938118 PMCID: PMC8687446 DOI: 10.2147/bctt.s256393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
Purpose The aim of this systematic review is to update and synthesize new evidence on BREAST-Q questionnaire’s ability to reflect patient-reported outcomes in women who have undergone breast reconstruction surgery (BRS) following mastectomy. Methods PubMed, Science Direct, Google Scholar, Cochrane CENTRAL, and Clincaltrial.gov were searched for relevant studies from January 2009 to September 2021. Any interventional or observational studies that used BREAST-Q to assess patient-reported outcomes in the assessment of BRS following mastectomy were included. Results A total of 42 studies were eligible for inclusion in the review. Three were randomized controlled trials and 39 were observational studies. Compared with pre-operative scores, there was an improvement in all BREAST-Q outcome domains following BRS including ‘satisfaction with breasts’, “satisfaction with outcome” “psychosocial”, “physical”, and “sexual wellbeing”. Sexual well-being had the lowest BREAST-Q score both pre-and post-operatively (37.8–80.0 and 39.0–78.0, respectively). Autologous BRS reports higher satisfaction and overall wellbeing compared to implant-based BRS. BREAST-Q has a higher and narrow internal consistency of 0.81 to 0.96 compared with other patient-reported outcome measures (PROMs; EORTC-QLQ, FACT-B, BR-23, BCTOS). The BREAST-Q questionnaire is the only PROM which allows patients to reflect on their care, surgical outcomes, and satisfaction collectively. Conclusion This review highlights the fact that BREAST-Q can effectively and reliably measure satisfaction and wellbeing of breast cancer patients after BRS. Comparatively, sexual wellbeing shows poorer outcomes following BRS and more longitudinal studies are necessary to understand the basis for these findings. Compared to other PROMs, BREAST-Q is reliable and specific to breast cancer surgery. Overall, BREAST-Q can help clinicians improve their quality of service, understand patient experiences, and may be used as an auditing tool for surgical outcomes.
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Affiliation(s)
- Ishith Seth
- Department of Surgery, Bendigo Health, Bendigo, Victoria, 3550, Australia
| | - Nimish Seth
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria, 3004, Australia
| | - Gabriella Bulloch
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Warren M Rozen
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, 3004, Australia
| | - David J Hunter-Smith
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, 3004, Australia
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Papadopoulos S, Colpaert SDM, Goulis DG, Nigdelis MP, Grimbizis GF, Tio J, Abdallah A. Treating Anisomastia and Tuberous Breast with Fat Grafting: Technique and Evaluation of Outcomes Using BREAST-Q Surveys. Aesthetic Plast Surg 2021; 45:2729-2741. [PMID: 33864117 DOI: 10.1007/s00266-021-02273-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the surgical correction of tuberous breast deformity, implants and regional flaps play a prominent role. Lately, fat grafting has been used as an alternative, but there is evidence that patient satisfaction is higher after correction with implants compared with lipofilling. METHODS We report a tuberous breasts correction series of ten cases, enrolled between 2015 and 2018. Percutaneous fasciotomies and fat grafting were performed by the Body-Jet technique. Analysis of outcomes was undertaken with BREAST-Q surveys. RESULTS The breast satisfaction scores increased from 0 to 75 (p < 0.01), the psychological well-being scores from 20 to 70 (p < 0.01) and the sexual well-being scores from 18.5 to 58 (p = 0.02), while the physical well-being scores remained stable (from 68 to 63, p = 0.2). The median outcome satisfaction score was 86. CONCLUSION Scores of patient-reported outcomes after lipofilling can reach and even exceed those of patients corrected with implants, at the cost of more interventions. Fat grafting is beginning to establish itself as a true alternative in the treatment of tuberous breast deformity in patients with the appropriate fat deposits. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sarantos Papadopoulos
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany.
- Private Practice, Vasillisis Olgas 158, 54645, Thessaloniki, Greece.
| | | | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Meletios P Nigdelis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios F Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Joke Tio
- Department of Obstetrics and Gynecology, Breast Center, Muenster University, Muenster, Germany
| | - Abdallah Abdallah
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany
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Fabrizio T, Guarro G, Filippini A, La Torre G, Grieco MP. INDICATIONS FOR LIMITATIONS OF THE OMENTAL PEDICLE FLAP IN IMMEDIATE BREAST RECONSTRUCTION - SURGICAL RESULTS EVALUATION AND BREAST-Q© 2.0 SURVEY. J Plast Reconstr Aesthet Surg 2021:S1748-6815(21)00604-5. [PMID: 34930701 DOI: 10.1016/j.bjps.2021.11.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/14/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIM Immediate reconstruction with an omental flap is a recognized suitable method for a full-thickness breast reconstruction or implant coverage for well-selected cases of nipple or skin-sparing mastectomies as well as cases of skin-reducing mastectomies. The authors' aim is the evaluation of indications and limitations of this technique with an original approach and also based on the analysis of patients' global satisfaction using the BREAST-Q 2.0© survey. MATERIALS AND METHODS From January 2014 to March 2018, 12 women aged between 29 to 67 years old (mean age: 49 years) underwent immediate breast reconstruction alone or with a definitive implant covered by a pedicled omental flap. All of them were asked to fill out the BREAST-Q© 2.0 survey. CONCLUSIONS The careful analysis of the cases shows that the indications for the immediate breast reconstruction based on the omental flap with a minimal resulting donor-site morbidity are strictly linked to its limitations, which are correctly reported in the study, but in the same way, it suggests that patients who underwent implant-based immediate breast reconstruction with omental flap reported significant improvements in satisfaction and health-related quality of their life.
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Skrzypczak T, Błachnio K, Górnicki T, Kmieć J, Ciąder A, Biernikiewicz M, Majchrowska M, Sobieszczańska M, Szymala-Pędzik M, Kałka D. Association between the Desire for Breast Augmentation and Instagram Engagement: A Cross-Sectional Survey among Young Polish Women. Int J Environ Res Public Health 2021; 18:10317. [PMID: 34639616 DOI: 10.3390/ijerph181910317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022]
Abstract
The impact of social media on the eagerness to undergo aesthetic breast surgery is unknown. We aimed to evaluate the association between Instagram engagement and the willingness to undergo breast augmentation. Women aged between 19–34 years old participated in an online survey. Of the 1560 respondents, 1226 (78.59%) met the inclusion criteria. BMI, bra type, bra cup size, education, and level of activity on Instagram increased the willingness to undergo breast augmentation (OR = 1.520, p = 0.020). Moreover, concurrent Snapchat use (OR = 1.348, p = 0.024) and the number of published posts on a respondent’s Instagram accounts (reference, n > 26; 0 < n ≤ 26; OR = 0.708, p = 0.009; lack of posts (n = 0): OR = 0.702, p = 0.155) were significant drivers of the respondents’ willingness. Fashion (OR = 0.730, p = 0.021), design/architecture (OR = 0.730, p = 0.022), and models (OR = 0.623, p = 0.004) were the searched content categories that increased the desire for breast augmentation. Positive and negative feeling scores that were triggered by Instagram content were correlated with BREAST-Q scores. We concluded that Instagram is a commonly used social network service among young women, and it may drive a desire for breast augmentation. Further analyses of Instagram preferences may help assess the willingness to undergo breast surgery, and in turn assist in tailoring marketing campaigns.
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