Satisfaction Rates after Breast Reconstruction
Satisfaction Rates of Breast Reconstruction
An article released by the American Society of Plastic Surgeons states that:
More than 180,000 women in the United States will be diagnosed with breast cancer this year, many of whom will have mastectomies. Nearly 79,000 breast reconstruction procedures following mastectomy were performed last year, a 166 percent increase since 1992, according to the American Society of Plastic Surgeons (ASPS.) At the ASPS 70th Annual Scientific Meeting in Orlando, Fla., four papers exploring various aspects of breast reconstruction will be presented.
The first study examined reconstruction in women who have or are at a high-risk for developing cancer in both breasts. These women chose to have both breasts removed. Overall, the women were found to be happy with the result. The study, which looked at 74 women, surveyed patients on their physical, emotional, social and general well being as well as on body image and breast and scar appearance.
“Women are understandably reluctant to have a healthy breast removed,” said Richard Redett, MD, fellow of plastic surgery at Johns Hopkins Hospital. “But we now can show them that women who do undergo bilateral mastectomies do very well. Along with possibly extending their life, they are happy with their body.”
The study concluded that there was no significant difference in quality of life between the different types of reconstruction. But women who had a bilateral pedicle TRAM flap (where the reconstructed breast comes from a portion of skin, fat and muscle taken from the abdomen and is tunneled beneath the skin to the chest while still connected to its original blood supply) scored higher in the areas of general body image, appearance of the reconstructed breast, how the breast feels to the touch and its appearance in a bra, compared to women who had other types of reconstruction.
The second study looked into the possibility of using implants for breast cancer patients who require radiation after reconstruction. It had previously been accepted that the use of skin expanders and implants (where an expandable balloon-like device is inserted beneath the skin, and over several weeks, the expander is gradually filled with salt water causing the overlying skin to stretch) did not work well in women whose treatment included radiation. It had been previously concluded that radiation did not allow the skin to expand, as well as possibly injuring the skin and losing the implant to infection.
In the study of 81 patients who had implant reconstruction followed by radiation, more than 80 percent had a good to excellent result. Eighty-two percent of the patients would choose the same method of reconstruction again. The rate of capsular contracture (when scar tissue forms around the implant, tightening and squeezing it) was 49 percent, but exhibited a very low level of distortion.
According to the European Journal of Plastic Surgery:
Delayed breast reconstruction following mastectomy for cancer is widely accepted because of a high satisfaction rate. Immediate breast reconstruction offers an even more satisfactory solution, especially related to recovery and self-esteem. In our study, immediate breast reconstruction was performed for three indications: breast cancer, high risk for development of breast cancer and chronic cystic breast disease. Forty-eight consecutive patients with a mean age of 48 years were evaluated. In 37 cases malignant disease, in eight patients prophylaxis, and in three patients benign disease were the reasons for mastectomy. In 42 patients, primary reconstruction was performed, using tissue expanders, followed by prosthetic replacement. Of the other six patients, three were reconstructed with a definitive prosthesis and three with a musculocutaneous flap. At the end of the follow-up period, 42 patients had a definitive prosthesis and two patients had their breasts reconstructed with autologous tissue only. Four patients stopped the procedure following infection and extrusion of their implants. These infections accounted for an overall complication rate of 24%. After starting perioperative antibiotic prophylaxis from the 20th patient onwards, the complication rate was reduced to 12%. Thirty-three patients could be interviewed to assess satisfaction: nine patients were very satisfied, 18 were satisfied and six were moderately satisfied with the end result. Thus, 82% of the patients were satisfied.
The Institute of Medicine reports:
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In the group of 100 women implanted, 85% would recommend implant reconstruction to other women, and 73% rated it 6-10 on a scale of 1-10 (32 women rated it a 10). However, this questionnaire was administered by the operating service during the post-operative period. Spear and Majidian (1998) asked patients to express their degree of satisfaction, and 98% of 42 consecutive women rated themselves somewhat to completely satisfied with their breast implants. Again, this rating was carried out by the operating team, presumably shortly after surgery. A survey by Francel et al. of 197 implant reconstruction patients, with a 50% response rate, found that 100% of women who had been reconstructed immediately would try it again and 90% of them were satisfied. Of women who had undergone delayed reconstruction with implants, 90% would try it again and 80% were satisfied. This is another example of a survey performed by the surgical group after an unspecified, but clearly short, postoperative interval.
View Mastectomy Reconstruction Before and After Photos