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Study: Women report greater satisfaction, quality of life with "flap" reconstruction

Andrea Pusic, MD

When women decide to undergo breast reconstruction after a mastectomy, they’re typically presented with two options for the procedure: an implant-based reconstruction or an autologous, or “flap,” reconstruction, which uses skin, fat or muscle from elsewhere in the body to rebuild the breast.

While demand for breast reconstruction surgery is rising, there has been limited evidence-based, patient-centered data about satisfaction and quality-of-life measures after the procedure.

In a new study, Brigham researchers evaluated patient-reported satisfaction and well-being outcomes for more than 2,000 women nationwide prior to their initial reconstruction surgery and two years afterward. They found that patients who underwent flap reconstruction had greater satisfaction with their breasts, as well as greater psychosocial and sexual well-being two years after surgery, compared to those who underwent implant reconstruction.

The findings, shared last month in JAMA Surgery, built on the one-year, patient-reported outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC).

“Patient-centered data can best inform patients and clinicians about the potential risks and expected outcomes of breast reconstruction when making a decision between implant-based or autologous breast reconstruction,” said Andrea Pusic, MD, MHS, FACS, FRCSC, Chief of the Division of Plastic and Reconstructive Surgery and senior author of the study. “Given the personal and intimate nature of breast reconstruction, patient-centered data are arguably the best measures of outcomes. Understanding the expectations and quality-of-life outcomes for previous patients may help new patients and their care providers in the decision-making process.”

A Closer Look: Flap vs. Implant

The study looked at patients from 11 centers, including the Brigham. Patient satisfaction with breasts, psychosocial well-being, physical well-being and sexual well-being were measured in scores on the BREAST-Q, a validated breast-surgery, patient-reported outcome questionnaire, calibrated to detect differences between specific procedure groups and patients over time.

In addition to their overall findings, Pusic and her team discovered that the differences in patient satisfaction with their breasts and their sexual well-being became greater at the two-year mark. For patients who underwent implant-based reconstruction, satisfaction rates declined over time, likely due to symmetry issues and the inability of the implant to age naturally.

After one year, no difference in the physical well-being of the chest was reported. At two years, patients who received flap reconstruction reported favorable outcomes for physical well-being of the chest compared with implant reconstruction, but the difference remained small.

Importantly, although patients reported overall high satisfaction with flap reconstruction, physical well-being of the abdomen was not fully restored, even though approximately two-thirds of the autologous patients had muscle-sparing or perforator flap procedures. The authors note that additional research and innovation is required to further minimize the negative effect of flap harvest on abdominal wall function.

Researchers said additional studies with even longer-term follow-up are warranted to determine the association of the type of reconstruction with patient-reported outcomes when radiation is required.

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