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Baker BG, Pieri A. Assessment of Patient-Reported Outcomes for Closed-Incision Negative Pressure Therapy with Wide-Coverage Dressings in Simple Mastectomy and Immediate Implant-Based Breast Reconstruction. Adv Wound Care (New Rochelle) 2024. [PMID: 38695108 DOI: 10.1089/wound.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objective: A new configuration of closed-incision negative pressure therapy (ciNPT) dressings now covers the incision and a broader area of peri-incisional tissues. We have implemented these ciNPT dressings following simple mastectomy (SM) or skin-sparing mastectomy with implant-based reconstruction (IBR). This study assesses patient-reported outcomes of this new protocol. Approach: Patients underwent SM or IBR for breast cancer. ciNPT with wide-coverage dressings were placed over the entire breast, and -125 mmHg was applied for 14 days. Upon dressing removal, patients rated their experience using the Wound-Q™ Suction Device Scale and recorded their satisfaction on a Likert scale ranging 1-5. Results: Thirteen SM patients and 12 IBR patients were included in the study. The median age was 62 years, and SM patients were significantly older (p < 0.01). Patients rated the ciNPT device highest on items relating to its function and appearance, and lowest on noise and interference with sleep and physical activity. The overall mean score for the combined cohort was 64.8/100. The mean score for SM patients (74.8 ± 19.9) was significantly greater than for IBR patients (53.9 ± 9.6, p < 0.01). The mean overall patient satisfaction rating was 3.92 on a 5-point scale; 4.0 in the SM group and 3.8 in the IBR group. Innovation: This study is the first to report on the patient experience with these newly available wide-coverage ciNPT dressings. Conclusion: Overall, the dressing was well-tolerated by patients, and satisfaction was high. The positive reception of ciNPT with wide-coverage dressings supports continued use at our hospital.
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Affiliation(s)
| | - Andrew Pieri
- Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Suzuki M, Komiya T, Asai M, Ayabe N, Hanano M, Kawai Y, Shimada K, Ishikawa T, Matsumura H. Effectiveness of SCAR-Q for assessment of incisional SCAR after implant-based reconstruction in breast cancer patients: Can it be a tool for incision selection? Int Wound J 2024; 21:e14822. [PMID: 38468433 PMCID: PMC10928237 DOI: 10.1111/iwj.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/10/2024] [Accepted: 02/18/2024] [Indexed: 03/13/2024] Open
Abstract
Incisional scarring is a factor of cosmetic appearance evaluated after breast reconstruction, along with the shape, position, and size of the breast. This study aimed to examine the effect of the incision scar location on patient satisfaction after breast reconstruction. Using the Japanese version of the SCAR-Q, we assessed the scar appearance, symptoms and psychosocial effects. Plastic surgeons performed assessments using the Manchester Scar Scale. The patients were divided into two groups: those with scars on the margins of the breast (MB group) and those with scars in the breast area (IB group). The results revealed that patients in the MB group reported significantly higher satisfaction with the scar appearance and psychological impact than those in the IB group. However, assessments using the Manchester Scar Scale did not reveal any significant differences between the two groups. In conclusion, this study underscores the importance of patient-reported outcomes in the evaluation of scar satisfaction after breast reconstruction. Patients tend to prefer and have higher satisfaction with scars along the breast margin, which offers valuable insights into surgical decisions. Further studies with larger and more diverse sample sizes are required for validation.
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Affiliation(s)
- Misa Suzuki
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Takako Komiya
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Maiko Asai
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Nanako Ayabe
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Mai Hanano
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Yuichiro Kawai
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Kazuki Shimada
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Takashi Ishikawa
- Department of Breast Oncology and SurgeryTokyo Medical UniversityTokyoJapan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
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Barbat P, Hu W, Rouanet M, Claudic Y, Henry AS. [Unilateral secondary breast reconstruction using a pedicled dorsal flap sparing the latissimus dorsi (TDAP and MSLD) in patients with a history of total mastectomy for breast cancer. Monocentric observational study]. ANN CHIR PLAST ESTH 2024; 69:136-153. [PMID: 38065785 DOI: 10.1016/j.anplas.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/18/2023] [Indexed: 02/26/2024]
Abstract
INTRODUCTION The use of pedicled dorsal flaps sparing the latissimus dorsi muscle (TDAP and MSLD flap) is a well-described reconstruction method in breast reconstruction after breast cancer. However, little data exists regarding patient satisfaction after this surgery. The main objective of this study was to evaluate patient satisfaction after unilateral total secondary breast reconstruction using a TDAP or MSLD flap. The secondary objectives corresponded to the evaluation of postoperative complications following this surgery, the evaluation of the duration of the reconstruction and the nature of additional interventions, the evaluation of the functional after-effects, and the evaluation of the chest size when the reconstruction is completed. MATERIAL AND METHOD This is a monocentric, retrospective cohort study, including 22 patients who underwent unilateral secondary total breast reconstruction using a TDAP or MSLD flap between January 1, 2018 and December 31, 2022. Patient satisfaction was assessed using three questionnaires validated in breast reconstruction: the Reconstruction module of the BREAST-Q, the MBROS-S and the MBROS-BI. RESULTS The MBROS-S satisfaction score is 71.4%. The MBROS-BI body image score is 62%. With the BREAST-Q, the Satisfaction with Breast score is estimated at 53.1; the Satisfaction with Back score is estimated at 75.5; the physical well-being score regarding the chest is evaluated at 71.7; the physical well-being score concerning the shoulder and back is evaluated at 67.4; the psychosocial well-being score is assessed at 67.4; the sexual well-being score is estimated at 48.7; and for women who have benefited from reconstruction associated with a prosthesis, the satisfaction score regarding the implant is 71.6. CONCLUSION Unilateral total secondary breast reconstruction with a dorsal pedicled flap sparing the latissimus dorsi muscle is an elegant, reliable, and respectful way to reconstruct a breast, and appears to give high levels of satisfaction.
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Affiliation(s)
- P Barbat
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - W Hu
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - M Rouanet
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - Y Claudic
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - A-S Henry
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
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Malapati SH, Hyland CJ, Liang G, Edelen MO, Fazzalari A, Kaur MN, Bain PA, Mody GN, Pusic AL. Use of patient-reported outcome measures after breast reconstruction in low- and middle-income countries: a scoping review. J Patient Rep Outcomes 2024; 8:25. [PMID: 38416222 PMCID: PMC10899941 DOI: 10.1186/s41687-024-00687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly administered in high-income countries to monitor health-related quality of life of breast cancer patients undergoing breast reconstruction. Although low- and middle-income countries (LMICs) face a disproportionate burden of breast cancer, little is known about the use of PROMs in LMICs. This scoping review aims to examine the use of PROMs after post-mastectomy breast reconstruction among patients with breast cancer in LMICs. METHODS MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched in August 2022 for English-language studies using PROMs after breast reconstruction among patients with breast cancer in LMICs. Study screening and data extraction were completed. Data were analyzed descriptively. RESULTS The search produced 1024 unique studies, 33 of which met inclusion criteria. Most were observational (48.5%) or retrospective (33.3%) studies. Studies were conducted in only 10 LMICs, with 60.5% in China and Brazil and none in low-income countries. Most were conducted in urban settings (84.8%) and outpatient clinics (57.6%), with 63.6% incorporating breast-specific PROMs and 33.3% including breast reconstruction-specific PROMs. Less than half (45.5%) used PROMs explicitly validated for their populations of interest. Only 21.2% reported PROM response rates, ranging from 43.1 to 96.9%. Barriers and facilitators of PROM use were infrequently noted. CONCLUSIONS Despite the importance of PROM collection and use in providing patient-centered care, it continues to be limited in middle-income countries and is not evident in low-income countries after breast reconstruction. Further research is necessary to determine effective methods to address the challenges of PROM use in LMICs.
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Affiliation(s)
- Sri Harshini Malapati
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.
| | - Colby J Hyland
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - George Liang
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Maria O Edelen
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Amanda Fazzalari
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Manraj N Kaur
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Gita N Mody
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
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Cimaroli S, Bichanich M, Adamson K, LoGiudice J, Doren E. Evaluating Both Partner and Patient Satisfaction With Postmastectomy Breast Reconstruction. Ann Plast Surg 2023; 91:698-701. [PMID: 38079316 DOI: 10.1097/sap.0000000000003657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
PURPOSE Few studies have looked in-depth at the relationship between patient and partner satisfaction with postmastectomy breast reconstruction. The studies that do exist suggest that perceived partner satisfaction is an important predictor of patient satisfaction in postmastectomy breast reconstruction. METHODS We created a novel survey designed to look at reconstruction outcomes from a partner's perspective. Patients with a history of mastectomy-alone or mastectomy with reconstruction at our institution from January 2011 through December 2020 were contacted electronically to complete a demographic form and the BREAST-Q, while partners completed our novel partner survey. Sixteen mastectomy-only and 76 mastectomy with reconstruction couples completed surveys. RESULTS The mean Breast-Q and partner survey scores were 87 and 87 (maximum possible = 100), respectively, for mastectomy with reconstruction. There was a correlation of 0.57 between patient and partner overall satisfaction. There was no difference in overall satisfaction between patients who underwent reconstruction and those who did not (P = 0.19). There was a relationship between satisfaction with preoperative counseling and overall satisfaction in both patients and partners. The partner survey was found to have high internal consistency for measuring various areas of partner satisfaction. CONCLUSIONS There is a relationship between patient and partner satisfaction with postmastectomy breast reconstruction. Our data may support the positive impact of social support on recovery after breast cancer treatment, as satisfaction was high in both groups. We therefore encourage partners to attend and participate in preoperative consultations. Finally, our novel partner survey is a reliable tool to assess partner satisfaction with postmastectomy breast reconstruction.
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Affiliation(s)
- Sawyer Cimaroli
- From the Medical College of Wisconsin Department of Plastic Surgery, Milwaukee, WI
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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] [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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7
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Nor S, Chan KG, Rahman HA, H. Abdul-Mumin K. Patient satisfaction of breast reconstructive surgery following mastectomy in Brunei. PLoS One 2023; 18:e0289955. [PMID: 37611034 PMCID: PMC10446170 DOI: 10.1371/journal.pone.0289955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 07/29/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To evaluate the impact of Breast Reconstructive Surgery (BRS) on patients' satisfaction and quality of life following mastectomy for breast cancer. METHODS A multi-method design study comprising quantitative and qualitative research was conducted between October to December 2019. The quantitative component consisted of a cross-sectional study using the Breast-Q questionnaire and the qualitative component involved in-depth interviews with eligible patients (N = 16) who underwent BRS following mastectomy for breast cancer. Quantitative analysis was performed including Fisher's exact test and One-way Analysis of Variance where a p-value of <0.05 was regarded as statistically significant. Qualitative data was thematically analysed using Braun and Clarke's thematic analysis. RESULTS 14 out of 16 eligible patients participated in the study. We observed the lowest-scale score was for 'satisfaction with nipples' (mean score 32.7), followed by 'physical well-being: abdomen' (mean score 69.5). Despite a median score of 70 for 'satisfaction with breasts', patients were satisfied with the overall outcome of BRS (median score 80.5). Thematic analysis yielded three themes i.e. "I feel beautiful again" that described patients' satisfaction with aesthetic outcome with autologous reconstruction; "Striving for normality" that indicated BRS established back a sense of normality and improve their self-confidence and lastly, "I was well taken care of" highlighted the importance of providing 'well-informed' care to ensure overall satisfaction of their BRS journey. CONCLUSION The uptake of BRS remains low since its availability in 2012, despite an overall increase in breast cancer cases in Brunei annually. Patients who underwent BRS have shown an increase BREAST-Q scores in breast satisfaction, psychosocial and sexual well-being after breast cancer treatment. Delivering high-quality patient-centred services and providing adequate information can influence the level of satisfaction for overall outcome. BRS should be considered as an important healthcare priority in Brunei and routinely be offered in the management of breast cancer.
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Affiliation(s)
- Shazana Nor
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- Department of Plastics Reconstructive Surgery, Ministry of Health, Bandar Seri Begawan, Brunei Darussalam
| | - Koo Guan Chan
- Department of Plastics Reconstructive Surgery, Ministry of Health, Bandar Seri Begawan, Brunei Darussalam
| | - Hanif Abdul Rahman
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Khadizah H. Abdul-Mumin
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Saiga M, Nakagiri R, Mukai Y, Matsumoto H, Kimata Y. Trends and issues in clinical research on satisfaction and quality of life after mastectomy and breast reconstruction: a 5-year scoping review. Int J Clin Oncol 2023:10.1007/s10147-023-02347-5. [PMID: 37160493 DOI: 10.1007/s10147-023-02347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
Breast reconstruction (BR) aims to improve the satisfaction and quality of life (QOL) of breast cancer survivors. Clinical studies using patient-reported outcomes (PROs) can therefore provide relevant information to the patients and support decision-making. This scoping review was conducted to analyze recent trends in world regions, methods used, and factors investigated. The literature search was conducted in August 2022. Databases of PubMed, MEDLINE, and CINAHL were searched for relevant English-language studies published from 2017 to 2022. Studies involving women with breast cancer who underwent BR after mastectomy and investigated PROs after BR using BR-specific scales were included. Data on the country, publication year, study design, PRO measures (PROMs) used, time points of surveys, and research themes were collected. In total, 147 articles met the inclusion criteria. BREAST-Q was the most widely used, contributing to the increase in the number and diversification of studies in this area. Such research has been conducted mainly in North America and Europe and is still developing in Asia and other regions. The research themes involved a wide range of clinical and patient factors in addition to surgery, which could be influenced by research methods, time since surgery, and even cultural differences. Recent BR-specific PROMs have led to a worldwide development of research on factors that affect satisfaction and QOL after BR. PRO after BR may be influenced by local cultural and social features, and it would be necessary to accumulate data in each region to draw clinically useful conclusion.
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Affiliation(s)
- Miho Saiga
- Department of Plastic Surgery, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan.
| | - Ryoko Nakagiri
- Department of Plastic Surgery, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yuko Mukai
- Department of Plastic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Hiroshi Matsumoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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9
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Gil-Olarte P, Gil-Olarte MA, Gómez-Molinero R, Guil R. Psychosocial and sexual well-being in breast cancer survivors undergoing immediate breast reconstruction: The mediating role of breast satisfaction. Eur J Cancer Care (Engl) 2022; 31:e13686. [PMID: 35989473 PMCID: PMC9786331 DOI: 10.1111/ecc.13686] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 07/05/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to explore (1) the levels of quality of life (psychosocial, physical and sexual well-being) and breast satisfaction in breast cancer patients (BCP) after immediate reconstruction (IR), considering surgery reason and surgical technique, and (2) the explanatory and predictive capacity of psychosocial well-being on breast satisfaction, and of both on sexual well-being. METHODS This prospective study included 36 BCP who underwent IR between June 2006 and December 2014. RESULTS Highest levels of quality of life were found in psychosocial well-being and sexual well-being, with no statistically significant differences by surgery reason or surgical technique in any quality of life indicator or breast satisfaction. Psychosocial, physical well-being and breast satisfaction explained 56.16% of the variance in sexual well-being, where 44.67% was attributed to psychosocial well-being. In addition, breast satisfaction statistically significantly mediated the relationship between psychosocial and sexual well-being, independently of physical well-being. CONCLUSION Our findings highlight the importance of IR in reducing psychological morbidity and preserving the quality of life and breast satisfaction. Furthermore, this research indicated that psychosocial well-being should be considered a useful personal resource for improving the sexual well-being of BCP undergoing IR both through its direct effect and the mediated effect of breast satisfaction.
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Affiliation(s)
- Paloma Gil-Olarte
- Department of Psychology, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INIBICA), Cádiz, Spain
- University Institute for Sustainable Social Development of the University of Cádiz (INDESS), Cádiz, Spain
| | | | - Rocío Gómez-Molinero
- Department of Psychology, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INIBICA), Cádiz, Spain
- University Institute for Sustainable Social Development of the University of Cádiz (INDESS), Cádiz, Spain
| | - Rocío Guil
- Department of Psychology, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INIBICA), Cádiz, Spain
- University Institute for Sustainable Social Development of the University of Cádiz (INDESS), Cádiz, Spain
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10
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Basso RB, Rodriguez BG, Palacios Huatuco RM, Coloccini A, Ramírez MF, Mayer HF. Usefulness of Glucose Measurement To Assess Tissue Perfusion of the Nipple-Areola Complex in Conservative Mastectomy: A Prospective Cohort Study Protocol. Int J Surg Protoc 2022; 26:68-72. [PMID: 35978840 PMCID: PMC9354559 DOI: 10.29337/ijsp.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/02/2022] [Indexed: 12/02/2022] Open
Abstract
In recent decades, the mastectomy technique has undergone progressive adaptations in order to preserve the integrity of the breast structure and the nipple-areola complex (NAC), allowing reconstruction to be performed immediately after ablation. However, mastectomy flap necrosis or NAC has become a common complication, with an incidence between 2% and 22.3%. Blood glucose measurement to monitor microsurgical flaps has been reported as a simple method for the early detection of venous compromise. In this scenario, we propose the need to use an alternative, cost-effective method to assess the vitality of NAC in conservative oncological mastectomies. This protocol describes a prospective cohort study and was approved by the Research Protocols Ethics Committee of our institution. Patients will be included after signing informed consent. The anonymity and confidentiality of the information collected will be respected according to the Declaration of Helsinki and according to local and national guidelines.
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Affiliation(s)
- Robertino B. Basso
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
| | - Breyner Garcia Rodriguez
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
| | - René M. Palacios Huatuco
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
| | - Alejandro Coloccini
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
| | - Mariano F. Ramírez
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
| | - Horacio F. Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
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11
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Fontein DB, Oros M, Held L, Giovanoli P, Pusic AL, Lindenblatt N. Patient-Reported Outcomes in Free-Flap Breast Reconstructive Surgery over Time (PRO-BREST). Breast Care (Basel) 2022; 17:272-278. [PMID: 35949418 PMCID: PMC9247488 DOI: 10.1159/000519804] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/02/2021] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROMs) are increasingly relevant to assess surgical quality and guide decisions in breast reconstruction (BR). Satisfaction with outcomes may change as time progresses. We assessed satisfaction in patients who underwent free-flap BR in the last 12 years. METHODS All patients who underwent free-flap BR from 2006 to 2018 were invited to complete the validated BREAST-Q for reconstruction. The BREAST-Q comprises 6 domains covering various aspects of satisfaction. Unadjusted linear regression assessed the relationship between different domains of the BREAST-Q and time since BR. Two-sample t tests assessed differences in satisfaction between patients who underwent BR ≥5 years versus <5 years prior. RESULTS Forty-three women with primary or secondary free-flap BR between 2006 and 2018 were included in the study. Most patients (n = 33, 76.7%) underwent DIEP flap BR. Overall satisfaction with breasts and with outcomes improved as time since BR increased (p = 0.031 and p = 0.017, respectively). Overall satisfaction with outcomes scored higher in patients with BR ≥5 years prior (≥5 years vs. <5 years: breast score 88.6 (SD 12.5) versus 66.9 (SD 21.8); p = 0.005). Satisfaction with breasts and psychosocial well-being also scored higher in these patients. There was no difference in results between primary and secondary BR. Patients who underwent additional surgery (refinements) reported higher satisfaction with outcomes and abdominal well-being. CONCLUSIONS PROMs concerning satisfaction with breast and with outcomes following BR improve as time since treatment progresses. This study demonstrates that time since diagnosis may be an important factor in satisfaction. It underlines the importance of long-term PROMs related to BR, to help provide patients and health care professionals in decision-making and in managing expectations related to BR.
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Affiliation(s)
- Duveken B.Y. Fontein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Melanie Oros
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Leonhard Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Andrea L. Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nicole Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
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12
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Oliveira IGED, Sabino Neto M, Amaro LC, Uehara HK, Ferreira LM, Veiga DF. Translation and cross-cultural adaptation of the Brazilian version of BREAST-Q©: breast reconstruction expectations module. REVISTA DA ASSOCIAÇÃO MÉDICA BRASILEIRA 2022; 68:498-501. [DOI: 10.1590/1806-9282.20211095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/25/2022] [Indexed: 11/21/2022]
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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] [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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14
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Everaars KE, Tjin EP, de Laat EH, Arends CR, Hummelink S, Ulrich DJ. Breast and abdominal scarring after DIEP flap breast reconstruction: an exploration of patient-reported scar quality. J Plast Reconstr Aesthet Surg 2022; 75:1805-1812. [DOI: 10.1016/j.bjps.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
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15
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Michael A, Olawoye O, Ademola S, Ugwu E, Sarimiye F, Ayandipo O, Aderibigbe R, Iyun A, Oluwatosin O. Postmastectomy breast reconstruction awareness and attitudes in Nigerian women with breast cancer: A descriptive, cross sectional survey. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Weick L, Brorson F, Jepsen C, Lidén M, Jensen EW, Hansson E. Giving meaning to patient reported outcomes in breast reconstruction after mastectomy - A systematic review of available scores and suggestions for further research. Breast 2021; 61:91-97. [PMID: 34929423 PMCID: PMC8693348 DOI: 10.1016/j.breast.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background There are three patient reported outcome measure instruments (PROMs) that have adequate content validity for breast reconstruction, BREAST-Q, BRECON-31 and EORTC QLQ-BRECON-23, and they all have been robustly validated. The aim of this study was to systematically review scores giving meaning to validated PROMs for breast reconstruction after mastectomy and discuss methods to enable interpretation of them. Methods A systematic review was performed according to the recommendations of PRISMA. Prospero CRD42021255874. Included articles had to meet criteria defined in a SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). The included studies were critically appraised using the GRADE approach. Results Three articles were finally included in the review: two studies on scores for healthy controls and one on minimally important differences (MIDs), both of BREAST-Q. All of the studies were performed in North America. Only MIDs based on statistical characteristics, and not on what constitutes a relevant change for the patient, exist. The risk of bias was evaluated as very high and moderate, respectively, of inconsistencies as low, of indirectness as high, of imprecisions as low, and of publication bias as probably low. Conclusions The overall certainty of evidence for scores giving meaning to PROMs for breast reconstruction is low (GRADE ƟƟОО). More studies are needed to establish relevant healthy control scores and what constitutes a relevant clinical difference for patient-reported outcome measures for breast reconstruction after mastectomy. Clinical implications of the findings and suggestions for further research are suggested in the article. Patient reported outcome measurements have to be clinically interpretable to make sense. Three articles on scores giving meaning to PROMs for breast reconstruction post-mastectomy exist. More studies are needed to establish relevant controls and clinical differences in scores. Clinical implications and suggestions for further research are discussed.
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Affiliation(s)
- Linn Weick
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Fredrik Brorson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Christian Jepsen
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Emmelie Widmark Jensen
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden; Department of Plastic Surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.
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Chae MP, Hunter-Smith DJ, Chung RD, Smith JA, Rozen WM. 3D-printed, patient-specific DIEP flap templates for preoperative planning in breast reconstruction: a prospective case series. Gland Surg 2021; 10:2192-2199. [PMID: 34422590 DOI: 10.21037/gs-21-263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 11/06/2022]
Abstract
Background Modern imaging technologies, such as computed tomographic angiography (CTA), can be useful for preoperative assessment in deep inferior epigastric artery perforator (DIEP) flap surgery. Planning perforator flap design can lead to improved surgical efficiency. However, current imaging modalities are limited by being displayed on a two-dimensional (2D) surface. In contrast, a 3D-printed model provides tactile feedback that facilitates superior understanding. Hence, we have 3D-printed patient-specific deep inferior epigastric artery perforator (DIEP) templates, in an affordable and convenient manner, for preoperative planning. Methods Twenty consecutive patients undergoing 25 immediate or delayed post-mastectomy autologous breast reconstruction with DIEP or muscle-sparing transverse rectus abdominis (MS-TRAM) flaps are recruited prospectively. Using free, open-source softwares (3D Slicer, Autodesk MeshMixer, and Cura) and desktop 3D printers (Ultimaker 3E and Moment), we created a template based on a patient's abdominal wall anatomy from CTA, with holes and lines indicating the position of perforators, their intramuscular course and the DIEA pedicle. Results The mean age of patients was 52 [38-67]. There were 15 immediate and 10 delayed reconstructions. 3D printing time took mean 18 hours and 123.7 g of plastic filament, which calculates to a mean material cost of AUD 8.25. DIEP templates accurately identified the perforators and reduced intraoperative perforator identification by 7.29 minutes (P=0.02). However, the intramuscular dissection time was not affected (P=0.34). Surgeons found the template useful for preoperative marking (8.6/10) and planning (7.9/10), but not for intramuscular dissection (5.9/10). There were no immediate flap-related complications. Conclusions Our 3D-printed, patient-specific DIEP template is accurate, significantly reduces intraoperative perforator identification time and, hence, may be a useful tool for preoperative planning in autologous breast reconstruction.
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Affiliation(s)
- Michael P Chae
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
| | - David J Hunter-Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
| | - Ru Dee Chung
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
| | - Warren Matthew Rozen
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
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18
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Patel AA, Arquette CP, Rowley MA, Borrelli MR, Lee GK, Nazerali RS. Comparing Outcomes of Flap-Based Salvage Reconstructions in the Radiated Breast. Ann Plast Surg 2021; 86:S403-S408. [PMID: 33976069 DOI: 10.1097/sap.0000000000002761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Chest wall irradiation significantly decreases the strength and quality of breast tissue supporting prostheses, increasing the risk of skin breakdown and implant or tissue expander extrusion. Autologous tissue, including the latissimus dorsi (LD) or abdominal-based flaps, including the muscle-sparing transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flaps, may be used to salvage reconstructions. However, data comparing outcomes of the two flap options remains limited. We compare postoperative outcomes from both flap types after autologous salvage reconstruction in irradiated breasts. METHODS Charts were retrospectively reviewed from patients who underwent either chest wall radiation or postmastectomy radiation therapy followed by salvage autologous reconstruction with either a LD and an implant or an abdominal-based flap (muscle-sparing transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flaps). Patients with a history of tissue expander or implant failure requiring autologous salvage as part of 2-staged or delayed-immediate breast reconstruction that were operated on between January 2005 and November 2015 were included. Basic demographics, comorbidities, and recipient site complications (infection, wound dehiscence, seroma, hematoma, fat necrosis, and flap failure) were collected. RESULTS A total of 72 patients met the inclusion criteria which included 72 flaps; 35 LD and 37 abdominally based flaps. Demographics and comorbidities did not vary significantly between patient groups. Mean follow-up was 767.6 weeks, and all reconstructions were unilateral. Nineteen (26.4%) patients had at least one complication, most commonly minor infections (9.7%). Overall complication rates were not significantly different between flap groups (P = 0.083). Wound dehiscence was significantly higher in the abdominal group (P = 0.045), and fat necrosis also trended higher in this group (P = 0.085). Major infection trended higher in the latissimus group (P = 0.069). CONCLUSIONS When comparing outcomes of salvage flap-based reconstruction in radiated breast tissue, overall complication rates were similar when comparing postoperative outcomes between the LD- and abdominal-based flaps. Wound dehiscence was significantly higher when salvage reconstruction used an abdominal flap. Understanding the complications after salvage procedures can help inform decision making and optimize patient care to improve outcomes after breast reconstruction in the radiated breast.
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Affiliation(s)
| | - Connor P Arquette
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Mallory A Rowley
- From the College of Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Gordon K Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
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Everaars KE, Welbie M, Hummelink S, Tjin EPM, de Laat EH, Ulrich DJO. The impact of scars on health-related quality of life after breast surgery: a qualitative exploration. J Cancer Surviv 2021; 15:224-233. [PMID: 32816201 PMCID: PMC7966197 DOI: 10.1007/s11764-020-00926-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/01/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE The purpose of this research was to explore women's experiences after breast surgery with scar characteristics and symptoms, and its impact on their health-related quality of life (HRQOL). MATERIAL AND METHODS A qualitative study using semi-structured face-to-face interviews was conducted among women following prophylactic, oncologic, or reconstructive breast surgery in the Netherlands. A directed content analysis was performed using guiding themes. Themes were "physical and sensory symptoms," "impact of scar symptoms," "personal factors," "impact of scar interventions," and "change over time." RESULTS The study population consisted of 26 women after breast surgery. Women experienced a wide range of symptoms like adherence, stiffness, pain, and uncomfortable sensations. Scar characteristics as visibility, location, texture, and size, influenced satisfaction with their appearance. The impact of scar symptoms is reflected in physical, social, emotional, and cognitive functioning, thereby affecting HRQOL. The experienced impact on HRQOL depended on several factors, like personal factors as the degree of acceptance and environmental factors like social support. CONCLUSION Women can experience a diversity of scar characteristics and symptoms, which play a central role in the perceived impact on HRQOL. Since scarring can have a considerable impact on HRQOL, scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice and research. IMPLICATIONS FOR CANCER SURVIVORS Considering scarring as a common late effect after breast surgery and understanding the variety of experiences, which could impact HRQOL of women, can be beneficial in sufficient information provision, expectation management, and informed decision making.
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Affiliation(s)
- Kristel E. Everaars
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
- Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Marlies Welbie
- Research Center Healthy and Sustainable Living, Research group Methodology of Practice-Based Research, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Stefan Hummelink
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
| | - Esther P. M. Tjin
- Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Erik H. de Laat
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
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20
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Spindler N, Ebel F, Briest S, Wallochny S, Langer S. Quality of Life After Bilateral Risk-Reducing Mastectomy and Simultaneous Reconstruction Using Pre-Pectoral Silicone Implants. Patient Prefer Adherence 2021; 15:741-750. [PMID: 33880017 PMCID: PMC8053496 DOI: 10.2147/ppa.s303208] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/13/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Bilateral risk-reducing mastectomy (BRRM) can reduce the risk of developing breast cancer by up to 95% in women with increased exposure. Although survival is increased, mastectomies can adversely affect a patient physically, psychologically, and psychosexually. High health-related quality of life (HRQoL) is often achieved after simultaneous breast reconstruction (BR) following BRRM; however, data on the pre- and postoperative results of HRQoL are lacking. Therefore, we investigated the quality of life, esthetic outcome, and patient well-being after BRRM and simultaneous implant-based BR. PATIENTS AND METHODS Of the 35 patients who underwent skin-sparing or nipple-sparing mastectomy between May 2012 and December 2017 at a university hospital, only 22 completed the evaluation. Baseline data and data on previous operations and operation techniques were retrieved from the patient's charts. BREAST-Q and short form-36 health survey (SF-36) questionnaires were used to evaluate patient satisfaction and HRQoL. RESULTS SF-36 analysis showed a significantly higher score for pain (p=0.043) in our population than in the general female population. Comparing the pre- and postoperative BREAST-Q results, a significant decrease in the physical well-being of the chest (p=0.0179) and a slight improvement in breast satisfaction were observed (p=0.3266). All patients were well-satisfied with the postoperative outcome, reconstruction, and perioperative surgeon care. CONCLUSION Bilateral mastectomy with simultaneous BR using pre-pectoral implants is associated with an HRQoL similar to that of the healthy population. Although bilateral mastectomy may have an immense effect on the psychological, physical, and social aspects, immediate BR preserves the outer appearance and improves self-esteem.
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Affiliation(s)
- Nick Spindler
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
- Correspondence: Nick Spindler Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, GermanyTel +49-341-9717140Fax +49-341-9717139 Email
| | - Franziska Ebel
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Briest
- Department of Gynecology, Women’s and Children’s Centre, University Hospital Leipzig, Leipzig, Germany
| | - Sandra Wallochny
- Department of Gynecology, Women’s and Children’s Centre, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Langer
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Patient reported outcomes associated with surgical intervention for breast cancer. Am J Surg 2020; 219:816-822. [DOI: 10.1016/j.amjsurg.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/22/2022]
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Siqueira HFF, Teixeira JLDA, Lessa Filho RDS, Hora EC, Brasileiro FF, Borges KDS, Brito ÉDAC, Lima MS, Marques AD, Moura AR, Figueiredo Júnior TC, de Oliveira TC, Vasconcelos AAS, Lima CA. Patient satisfaction and quality of life in breast reconstruction: assessment of outcomes of immediate, delayed, and nonreconstruction. BMC Res Notes 2020; 13:223. [PMID: 32307018 PMCID: PMC7169023 DOI: 10.1186/s13104-020-05058-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
Abstract
Objectives This study was conducted aiming to assess the quality of life and satisfaction of women who had mastectomy treated with and without breast reconstruction. Results A total of 81 women who had mastectomy were included, of whom 53 (65.4%) underwent breast reconstruction. Quality of life was not significantly better in the reconstruction group than the nonreconstruction group. Satisfaction with the surgically operated breast, whether reconstructed or not, was positively correlated with quality of life (p = 0.004). There was no significant difference in quality of life between women with immediate and late reconstruction. This study showed that the satisfaction of patients with the operated breast, reconstructed or not, is more important in quality of life than whether the breast was reconstructed or not. When we analyzed the quality of life of women who had mastectomy who were dissatisfied with their unreconstructed breasts, we observed that nonreconstruction had a negative impact on the quality of life.
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Affiliation(s)
- Hianga Fayssa Fernandes Siqueira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil. .,Federal University of Vale Do São Francisco, Paulo Afonso, Brazil.
| | | | | | - Evânia Curvelo Hora
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
| | | | | | - Érika de Abreu Costa Brito
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.,Brazil University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Brazil
| | - Marcela Sampaio Lima
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.,Brazil University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Brazil
| | | | - Alex Rodrigues Moura
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
| | | | | | | | - Carlos Anselmo Lima
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil. .,Brazil University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Brazil.
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23
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Livingston-Rosanoff D, Trentham-Dietz A, Hampton JM, Newcomb PA, Wilke LG. Evaluation of Long-Term Satisfaction with Breast Surgery in Patients Treated for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study. Ann Surg Oncol 2020; 27:2628-2636. [PMID: 32095924 DOI: 10.1245/s10434-020-08216-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Breast-conserving surgery (BCS) and mastectomy have equivalent survival for ductal carcinoma in situ (DCIS), allowing patients to participate in selecting a personalized surgical option; however, this decision-making role can increase patient anxiety. Data evaluating patient satisfaction with their decision to undergo BCS versus mastectomy for the treatment of DCIS are limited. METHODS Women with DCIS were enrolled in a population-based, state-wide cohort from 1997 to 2006. Participants were surveyed about their satisfaction with their surgical and reconstruction decisions. Quality-of-life (QoL) evaluations were performed with biennial follow-up surveys though 2016. Multivariable logistic regression modeling examined the relationship between type of surgery and reconstruction with patient satisfaction. RESULTS Overall, 1537 women were surveyed, on average, 2.9 years following DCIS diagnosis. Over 90% reported satisfaction with their treatment decision regardless of surgery type. Women who underwent mastectomy with reconstruction were more likely to report lower levels of satisfaction than women who underwent BCS (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.18-7.51, p < 0.01). However, over 80% of women who underwent mastectomies reported satisfaction with their reconstruction decision. Women without reconstruction had the highest levels of satisfaction, while women with implants were more likely to be dissatisfied (implant + autologous: OR 2.77, 95% CI 1.24-6.24; implant alone: OR 4.02, 95% CI 1.947-8.34, p ≤ 0.01). QoL scores were not associated with differences in surgical or reconstruction satisfaction at 5, 10, and 15 years following DCIS diagnosis. CONCLUSIONS Women undergoing surgery for DCIS express satisfaction with their treatment decisions. Following mastectomy, most women are satisfied with their reconstruction decision, including women who did not undergo reconstruction.
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Affiliation(s)
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Lee G Wilke
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA
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Robot-assisted Mastectomy Followed by Immediate Autologous Microsurgical Free Flap Reconstruction: Techniques and Feasibility in Three Different Breast Cancer Surgical Scenarios. Clin Breast Cancer 2019; 20:e1-e8. [PMID: 31780382 DOI: 10.1016/j.clbc.2019.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 11/23/2022]
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25
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Sharif-Askary B, Vernon R, Broadwater G, Lane WO, Pomann GM, Hollenbeck ST. Subjective and objective evaluation of breast temperature following post-mastectomy reconstruction. Breast J 2019; 26:571-573. [PMID: 31493299 DOI: 10.1111/tbj.13599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Rebecca Vernon
- Duke University School of Medicine, Durham, North Carolina
| | - Gloria Broadwater
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Whitney O Lane
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Scott T Hollenbeck
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
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26
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Morley R, Leech T. Optimal assessment tools in assessing breast surgery: patient reported outcome measures (PROMs) vs. objective measures. Gland Surg 2019; 8:416-424. [PMID: 31538067 DOI: 10.21037/gs.2019.02.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Improving the health-related quality of life (HRQoL) of patients is the fundamental aim of aesthetic breast surgery and its importance is increasingly recognised in breast cancer-related surgery. There has been growing acceptance of the value of assessing physical, psychological and social well-being through patient reported outcome measures (PROMs). It is important to consider the role of PROMs in relation to objective measures to ensure that the optimal assessment tools are selected when assessing outcomes in breast surgery. A narrative review was conducted of published articles identified on Ovid Medline by searching the terms: patient reported outcome measures, quality of life (QoL), functional outcomes, aesthetic outcomes, complications and breast surgery. Reference lists were also examined to find relevant articles not detected through the search. Survival and mortality are outcomes of immense importance in breast surgery that are not suitable for assessment through PROMs and should be measured objectively. Post-operative complication rates and markers of their severity are most appropriately assessed using objective measures, however, patients may provide valuable insights into the impact complications have on their QoL. All current assessment tools for assessing aesthetic outcome have inherent limitations, and thus it is likely that both subjective and objective measures are required to comprehensively assess aesthetic outcomes in breast surgery. Physical dysfunction can be assessed objectively, however, PROMs may better evaluate physical well-being, reflecting the real-life implications of a change in function. Psychological and social well-being is irrefutably personal in nature and best assessed through PROMs. There is no one optimal assessment tool for assessing breast surgery outcomes. Utilising a combination of PROMs and objective measures is necessary to accurately and comprehensively evaluate the impact and effectiveness of surgical breast interventions.
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Affiliation(s)
| | - Tristan Leech
- Monash University, Victoria, Australia.,Department of Surgery, Peninsula Health, Victoria, Australia
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27
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Flitcroft KL, Brennan ME, Spillane AJ. The impact on Australian women of lack of choice of breast reconstruction options: A qualitative study. Psychooncology 2019; 28:547-552. [PMID: 30620117 DOI: 10.1002/pon.4974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many studies have demonstrated the positive impact of breast reconstruction (BR) on women following mastectomy for breast cancer. However, women's preferences for BR are not always considered by surgeons prior to mastectomy. The aim of this research is threefold: to document the negative impact lack of choice has had on some Australian women; to explore potential reasons for the absence of informed discussion; and to develop a prompt list of discussion topics to aid informed decision making. METHODS This research is part of a larger study using semistructured telephone or face-to-face interviews with women with breast cancer, surgeons, and health professionals to explore ways of improving access to BR. This article focuses on responses from all 22 women who reported negative BR experiences and seven of 31 surgeons who had made comments relevant to limiting BR discussion and choice. RESULTS The impact of a lack of information or choice at the time of mastectomy was often extreme and long-term. Breast surgeons are the gate keepers to accessing BR but too often appeared to limit women's choices. Interviews revealed cases where BR was not offered prior to mastectomy, even though it was available locally; where BR was not available locally, but patients were not informed about BR options available in other locations; where only delayed BR options were discussed; and where the type of BR being offered did not match patient preferences. CONCLUSION We have suggested essential BR discussion points to be raised with all clinically eligible women interested in considering BR.
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Affiliation(s)
- Kathy L Flitcroft
- Breast & Surgical Oncology, The Poche Centre, North Sydney, Australia.,Northern Clinical School, University of Sydney, North Sydney, Australia
| | - Meagan E Brennan
- Breast & Surgical Oncology, The Poche Centre, North Sydney, Australia.,Northern Clinical School, University of Sydney, North Sydney, Australia
| | - Andrew J Spillane
- Breast & Surgical Oncology, The Poche Centre, North Sydney, Australia.,Northern Clinical School, University of Sydney, North Sydney, Australia.,Breast & Melanoma Surgery, Mater Hospital, North Sydney, Australia.,Breast & Melanoma Surgery, Royal North Shore Hospital, St Leonards, Australia
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28
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Murphy BL, Hanson KT, Hieken TJ, McLaughlin S, Gray RJ, Habermann EB. Patient-reported experience after outpatient breast surgery. Am J Surg 2018; 218:175-180. [PMID: 30554667 DOI: 10.1016/j.amjsurg.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/23/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Given the growing emphasis on patient-centered care, we determined contributory factors to a positive experience among patients undergoing outpatient breast procedures. METHODS We retrospectively identified patients ≥18 years-old who underwent a breast operation 7/2015-12/2016 and completed a survey within two weeks. Univariate analyses evaluated associations of factors with top survey composite measures. Key driver analysis identified top-priority survey factors for improving the overall assessment measure. RESULTS Of 270 patients, patients who gave a top surgeon score were older (mean 62.5 vs 58.6 years, p = 0.048), more likely to report a pain score of 0 before discharge (87% vs 68%, p < 0.01), and were 30.8 times more likely to give a top rating overall (p < 0.01) than those who gave a lower surgeon score. Key driver analysis identified personal issues as the main target for improvement. CONCLUSION To achieve top outpatient ratings, providers should focus on personal issues, including pain control, especially in younger patients. Surgeons should consider focusing on involving the patient in treatment decisions and emphasizing pain control and overall needs to improve the patient experience.
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Affiliation(s)
- Brittany L Murphy
- Department of Surgery, Mayo Clinic, Rochester, MN, USA; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
| | - Kristine T Hanson
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Elizabeth B Habermann
- Department of Surgery, Mayo Clinic, Rochester, MN, USA; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA.
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29
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Yoon-Flannery K, DeStefano LM, De La Cruz LM, Fisher CS, Lin LY, Coffua LS, Mustafa RE, Sataloff DM, Tchou JC, Brooks AD. Quality of life and sexual well-being after nipple sparing mastectomy: A matched comparison of patients using the breast Q. J Surg Oncol 2018; 118:238-242. [DOI: 10.1002/jso.25107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/28/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Kahyun Yoon-Flannery
- Sidney Kimmel Comprehensive Breast Center; Jefferson Health New Jersey; Sewell New Jersey
| | | | - Lucy M. De La Cruz
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Carla S. Fisher
- Department of Surgery; Indiana University School of Medicine; Indianapolis Indiana
| | - Lisa Y. Lin
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Lauren S. Coffua
- Philadelphia College of Osteopathic Medicine; Philadelphia Pennsylvania
| | | | - Dahlia M. Sataloff
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Julia C. Tchou
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Ari D. Brooks
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
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30
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Svensson-Björk R, Hasselmann J, Acosta S. Evaluation of inguinal vascular surgical scars treated with closed incisional negative pressure wound therapy using three-dimensional digital imaging-A randomized controlled trial on bilateral incisions. Wound Repair Regen 2018; 26:77-86. [PMID: 29381241 DOI: 10.1111/wrr.12615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/23/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE OF THE INVESTIGATION Scar formation is an important, permanent surrogate marker for wound healing. The main aim of this randomized trial was to evaluate the effects of incisional negative pressure wound therapy (iNPWT) on scar formation in uncomplicated wound healing with 3-dimensional (3D) digital imaging. BASIC PROCEDURES Patients undergoing bilateral inguinal incisions after vascular surgery were randomized to receive iNPWT and standard dressing on separate sides. The incisional scars were documented at a median time of 808 days (range 394-1194) after surgery with 3D photography, which were objectively evaluated by two plastic surgeons using the Stony Brook scar evaluation scale (SBSES) and a 10-point graded numeric ranking scale (NRS10). Subjective evaluation was performed with the patient observer scar assessment scale (POSAS). Patients with surgical site infection or other wound complications were excluded to minimize bias. The p-values were calculated using McNemar's and Wilcoxon signed-rank test for paired nominal and paired continuous data, respectively. MAIN FINDINGS Among 33 patients, 32 patients had undergone endovascular aortic repair (EVAR) and 31 patients had transverse inguinal incisions. Objective and subjective scar evaluation showed no difference between iNPWT and standard dressing. In objective scorings, 18.8 and 21.9% received the highest possible SBSES total score in the iNPWT and standard dressing groups, while 43.8 and 37.5% received the highest possible NRS10 score, respectively. The inter-rater reliability between the two assessors for SBSES total score and NRS10 showed an intra-class correlation (ICC) of 0.78 and 0.68 for NPWT and 0.70 and 0.77 for traditional dressing, respectively. PRINCIPAL CONCLUSION The present randomized trial showed that iNPWT and standard dressings on closed transverse inguinal incisions after EVAR resulted in equal subtle scar formation. Objective scar evaluation with 3D images showed good inter-rater agreement.
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Affiliation(s)
- Robert Svensson-Björk
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Julien Hasselmann
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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31
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Matthews H, Turner A, Williamson I, Clyne W. 'It's a silver lining': A template analysis of satisfaction and quality of life following post-mastectomy breast reconstruction. Br J Health Psychol 2018; 23:455-475. [PMID: 29498475 DOI: 10.1111/bjhp.12299] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 01/22/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In the United Kingdom, the number of women undergoing post-mastectomy breast reconstruction is increasing. Consequently, exploring patient-reported outcomes in breast surgery has become increasingly important. This study investigated satisfaction and quality of life following post-mastectomy breast reconstruction. DESIGN Qualitative research design. METHODS In-depth, semi-structured telephone interviews were conducted with 25 women (age, M = 53.08, SD = 8.41) following breast reconstruction in the United Kingdom. Data were analysed using template analysis which produced three-first-level, 13 second-level, and 19 third-level themes. RESULTS Following reconstruction, women reported improved emotional functioning, although this was often accompanied by deterioration in physical, sexual, and/or social functioning. Women positively appraised their breast appearance, although some reported a decline in satisfaction over time, attributing this decline to their chosen reconstructive technique. Many women accepted the inevitability of scarring and most perceived their scars as a representation of their journey, signifying survival. Generally, women were satisfied with the outcome of their reconstruction, although on reflection some would not have opted for reconstruction. Following breast reconstruction, women were increasingly likely to experience the fear of recurrence, attributed to no longer being able to have a mammogram on the affected breast(s). CONCLUSIONS This study provides new insights into post-mastectomy breast reconstruction and is a novel application of template analysis. The analysis demonstrates only slight variation in some categories of experience among women, despite a heterogeneous sample. The findings allow researchers and clinicians to focus on specific dimensions of satisfaction and quality of life to support the needs of women following reconstruction. Statement of contribution What is already known on this subject? Patient satisfaction and quality of life are key patient-reported outcomes of breast reconstruction, although relatively few studies distinguish between types of satisfaction. The number of women electing to undergo reconstructive surgery is steadily increasing. As a consequence, exploring patient-reported outcomes in reconstructive breast surgery has become increasingly important for research and clinical practice. It is often suggested that breast reconstruction offers psychosocial benefits, although within the literature some mixed findings have been reported. Therefore, a qualitative exploration has the potential to add some clarity to the experiences of women following post-mastectomy breast reconstruction. What does this study add? To our knowledge, this is the first study to employ template analysis to explore the experiences of women following post-mastectomy breast reconstruction. Template analysis demonstrated that there was only slight variation in some categories of experience among women, despite a heterogeneous sample. This study distinguishes between the patient-reported outcomes breast satisfaction and outcome satisfaction to identify the key factors that are involved in determining satisfaction. The findings allow researchers and clinicians to focus on specific dimensions of satisfaction and quality of life which require improvement to support the unmet needs of women following breast reconstruction. The study presents two novel findings. Women attributed the fear of cancer recurrence to no longer being able to have a mammogram on the affected breast(s). Women also reported a decline in appearance-related satisfaction over time due to either the ptotic nature of autologous-based reconstruction or the fuller projected breast implant-based reconstruction affords.
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Affiliation(s)
- Hannah Matthews
- Faculty of Health & Life Sciences, Centre for Technology Enabled Health Research, Coventry University, UK
| | - Andrew Turner
- Faculty of Health & Life Sciences, Centre for Technology Enabled Health Research, Coventry University, UK
| | - Iain Williamson
- Health and Life Sciences, School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Wendy Clyne
- Faculty of Health & Life Sciences, Centre for Technology Enabled Health Research, Coventry University, UK
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