Patient-Reported Satisfaction and Quality of Life in Postmastectomy Radiated Patients: A Comparison between Delayed and Delayed Immediate Autologous Breast Reconstruction in a Predominantly Minority Patient Population

Patient-Reported Satisfaction and Quality of Life in Postmastectomy Radiated Patients: A Comparison between Delayed and Delayed Immediate Autologous Breast Reconstruction in a Predominantly Minority Patient Population

Abstract Background Delayed immediate (DI) autologous breast reconstruction consists of immediate postmastectomy tissue expander placement, radiation therapy, and subsequent autologous reconstruction. The decision between timing of reconstructive methods is challenging and remains to be elucidated. We aim to compare patient reported outcomes and quality of life between delayed and DI reconstruction. Methods A retrospective review of all patients, who underwent autologous breast reconstruction at Montefiore Medical Center from January 2009 to December 2016, was conducted. Patients who underwent postmastectomy radiotherapy were divided into two cohorts: delayed and DI autologous breast reconstruction. Patients were mailed a BREAST-Q survey and their responses, demographic information, complications, and need for revisionary procedures were analyzed. Results A total of 79 patients met inclusion criteria: 34.2% (n = 27) in the delayed and 65.8% (n = 52) in the DI group. 77.2% (n = 61) of patients were a minority population. Patients in each cohort had similar baseline characteristics; however, the DI cohort was more likely to have bilateral reconstruction (46.2% [n = 24] vs. 7.4% [n = 2]; p = 0.0005) and to have major mastectomy flap necrosis (22.4% [n = 17] vs. 0.0% [n = 0]; p = 0.002). Premature tissue expander removal occurred in 17.3% (n = 9) of patients in the DI group. BREAST-Q response rates were 44.4% (n = 12) in the delayed group and 57.7% (n = 30) in the DI group. Responses showed similar satisfaction with their breasts, well-being, and overall outcome. Conclusion Delayed and DI autologous breast reconstruction yield similar patient-reported satisfaction; however, patients undergoing DI reconstruction have higher rates of major mastectomy necrosis. Furthermore, patients in the DI group risk premature tissue expander removal.

摘要 背景 延迟即刻（DI）自体乳房重建包括乳房切除术后即刻放置组织扩张器、放射治疗以及随后的自体重建。重建方法时机的选择具有挑战性且仍有待阐明。我们旨在比较延迟重建和DI重建患者报告的结果以及生活质量。 方法 对2009年1月至2016年12月在蒙特菲奥里医疗中心接受自体乳房重建的所有患者进行回顾性研究。将乳房切除术后接受放射治疗的患者分为两组：延迟自体乳房重建组和DI自体乳房重建组。向患者邮寄BREAST - Q调查问卷，并对其回复、人口统计学信息、并发症以及再次手术的需求进行分析。 结果 共有79例患者符合纳入标准：延迟组占34.2%（n = 27），DI组占65.8%（n = 52）。77.2%（n = 61）的患者为少数族裔。每组患者的基线特征相似；然而，DI组更有可能进行双侧重建（46.2%[n = 24]对7.4%[n = 2]；p = 0.0005），且更易发生乳房切除皮瓣大面积坏死（22.4%[n = 17]对0.0%[n = 0]；p = 0.002）。DI组中有17.3%（n = 9）的患者过早取出组织扩张器。BREAST - Q回复率在延迟组为44.4%（n = 12），在DI组为57.7%（n = 30）。回复显示患者对乳房、健康状况和总体结果的满意度相似。 结论 延迟自体乳房重建和DI自体乳房重建在患者报告的满意度方面相似；然而，进行DI重建的患者乳房切除皮瓣大面积坏死的发生率更高。此外，DI组患者有过早取出组织扩张器的风险。