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Gallo L, Rae C, Kim PJ, Voineskos SH, Thoma A, Pusic AL, Klassen AF, Cano SJ. Establishing test-retest reliability and the smallest detectable change of FACE-Q Aesthetic Module scales. J Plast Reconstr Aesthet Surg 2024; 95:231-238. [PMID: 38936334 DOI: 10.1016/j.bjps.2024.06.002] [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: 04/02/2024] [Accepted: 06/02/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The test-retest (TRT) reliability of FACE-Q Aesthetic scales is yet to be assessed. The aim of this study was to establish the TRT reliability of 17 FACE-Q Aesthetic scales and determine the smallest detectable change (SDC) that can be identified using these scales. METHODS Data were collected from an online international sample platform (Prolific). Participants ≥20 years old, who had been to a dermatologist or plastic surgeon for a facial aesthetic treatment within the past 12 months were asked to provide demographic and clinical information and complete an online REDcap survey consisting of 17 FACE-Q Aesthetic scales. Participants were asked if they would be willing to complete the survey again in 7 days. Only the participants who reported no important change in the scale construct and completed the retest within 14 days were included. RESULTS A total of 342 unique participants completed the TRT survey. The mean age of the sample was 36.6 (±11.5) years, and 82.4% were female. With outlier data removed, all FACE-Q scales demonstrated an intraclass correlation coefficient >0.70 indicating "good" TRT reliability. The standard error of measurement for the included scales ranged from 3.37 to 11.87, corresponding to a range of SDCgroup from 0.95 to 3.23 and SDCind from 9.34 to 32.91. CONCLUSION All included FACE-Q scales demonstrated sufficient TRT reliability and stability overall after the outlier data were removed. Moreover, the authors calculated the values for the SDC for these scales.
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Affiliation(s)
- Lucas Gallo
- Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada.
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Patrick J Kim
- Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Sophocles H Voineskos
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
| | - Achilles Thoma
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Andrea L Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Liu J, Chen C, Chen H, Xiang A, Zheng R, Hu S, Guo J, Qu L, Zhou J, Wu J. Patient-Reported Outcomes and Complication Profiles of Implant-Based Breast Reconstruction in Patients With Postmastectomy Radiation Therapy. Ann Plast Surg 2024; 93:22-29. [PMID: 38885161 DOI: 10.1097/sap.0000000000003974] [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: 06/20/2024]
Abstract
OBJECTIVE This study aims to investigate the patient-reported outcomes (PROs) and complications of distinct implant-based breast reconstruction modality for patients with postmastectomy radiation therapy (PMRT). METHODS A retrospective review was conducted on breast cancer patients with stage II-III disease who performed implant-based breast reconstruction following with PMRT between September 2016 and April 2022. The patients were categorized into two matched groups: (1) patients receiving prepectoral breast reconstruction (PBR) or (2) subpectoral breast reconstruction (SBR) followed by PMRT. Following reconstruction, the patients were further compared for PMRT with the tissue expander (PMRT-TE) versus PMRT with permanent implant (PMRT-PI). PROs were measured with BREAST-Q questionnaire. Early and late complications were recorded and analyzed. RESULTS A total of 55 eligible patients were recruited. Patients who underwent PBR reported significantly higher satisfaction with breasts scores (P = 0.003) compared with the SBR group. The PMRT-TE group had higher satisfaction with breasts (P = 0.001) but lower physical well-being (P = 0.029) scores compared with PMRT-PI group. Moreover, patients in SBR cohort had a higher risk of capsular contracture (Baker grade III or IV) (20.5% vs 6.3%) and implant dislocation (48.7% vs 12.5%) than patients in PBR cohort. Patients in PMRT-PI group had a slightly higher rate of capsular contracture (Baker grade III or IV) than PMRT-TE group (20.8% vs 12.9%). CONCLUSIONS PBR was associated with lower rates of late complications, especially for implant dislocation, and higher satisfaction with breasts scores compared to SBR. In addition, compared to PMRT-TE with PMRT-PI, patients in PMRT-TE cohort reported superior PROs of satisfaction with breasts.
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Affiliation(s)
- Jian Liu
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Cong Chen
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Honggang Chen
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Aizhai Xiang
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Ruzhen Zheng
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Shufang Hu
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Jufeng Guo
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Li Qu
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Jun Zhou
- From the Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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Dalaei F, Dijkhorst PJ, Möller S, de Vries CEE, Poulsen L, Voineskos SH, Kaur MN, Thomsen JB, van Veen RN, Juhl CB, Andries A, Støving RK, Cano SJ, Klassen AF, Pusic AL, Sørensen JA. Minimal important difference in weight loss following bariatric surgery: Enhancing BODY-Q interpretability. Clin Obes 2024:e12675. [PMID: 38777325 DOI: 10.1111/cob.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/04/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
BODY-Q is a patient-reported outcome measure for comprehensive assessment of outcomes specific to patients undergoing bariatric surgery. The clinical utility of BODY-Q is hampered by the lack of guidance on score interpretation. This study aimed to determine minimal important difference (MID) for assessment of BODY-Q. Prospective BODY-Q data from Denmark and the Netherlands pre- and post-bariatric surgery were collected. Two distribution-based methods were used to estimate MID by 0.2 standard deviations of baseline scores and the mean standardized response change of scores from baseline to 3-years postoperatively. In total, 5476 assessments from 2253 participants were included of which 1628 (72.3%) underwent Roux-en-Y gastric bypass, 586 (26.0%) sleeve gastrectomy, 33 (1.5%) gastric banding, and 6 (0.03%) other surgeries. The mean age was 45.1 ± 10.9 with a mean BMI of 46.6 ± 9.6. Baseline MID ranged from 1 to 4 in health-related quality of life (HRQL) and from 2 to 8 in appearance scales. The mean change of scores ranged from 4 to 5 in HRQL and from 4 to 7 in the appearance scales. The estimated MID for the change in BODY-Q HRQL and appearance scales ranged from 3 to 8 and is recommended for use to interpret BODY-Q scores and assess treatment effects in bariatric surgery.
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Affiliation(s)
- Farima Dalaei
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- OPEN: Open Patient data Explorative Network, Odense, Denmark
| | - Phillip J Dijkhorst
- Department of Surgery, OLVG West Hospital & Dutch Obesity Clinic (NOK), Amsterdam, The Netherlands
| | - Sören Möller
- OPEN: Open Patient data Explorative Network, Odense, Denmark
- Odene University Hospital and University of Southern Denmark, Odense, Denmark
| | - Claire E E de Vries
- Department of Surgery, OLVG West Hospital & Dutch Obesity Clinic (NOK), Amsterdam, The Netherlands
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Lotte Poulsen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Sophocles H Voineskos
- Division of Plastic Surgery, Department of Surgery, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Manraj N Kaur
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jørn Bo Thomsen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | | | - Claus B Juhl
- Hospital of Southwest Jutland, Institute for Regional Health Research, University of Southern Denmark and Steno Diabetes Center, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Alin Andries
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - René K Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | | | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jens A Sørensen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
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Nierich J, Corten E, de Jong T, Mureau M. Long-Term Patient-Reported Outcomes following Oncological Facial Reconstructive Surgery using the FACE-Q Skin Cancer Module. JPRAS Open 2024; 39:262-270. [PMID: 38351901 PMCID: PMC10861937 DOI: 10.1016/j.jpra.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
Background Long-term patient-reported outcomes (PROs) of oncological facial reconstructive surgery are unknown. Objective The present study aimed to assess long-term PROs and to identify possible correlations between patient and treatment characteristics and long-term PROs. Methods & Materials Between 2006 and 2011, 202 patients underwent facial reconstruction after Mohs micrographic surgery for non-melanoma skin cancer at our institution. After 10 years of follow-up, 96 out of the remaining 122 patients completed the FACE-Q Skin Cancer Module. Results Patients who were surgically treated for squamous cell carcinoma reported poorer scores on the satisfaction with facial appearance (p=0.038), appraisal of scars (p=0.039) and appearance-related psychosocial distress scales (p=0.036) compared to patients with basal cell carcinoma and lentigo maligna. Finally, female patients reported significantly higher scores on the Cancer Worry Scale than male patients (p=0.047). Conclusion Long-term patient satisfaction with respect to their facial appearance and scars after reconstructive surgery for skin cancer was comparable to short-term patient satisfaction, whereas Cancer Worry Scale and psychosocial distress appeared to be slightly higher. Our results can be used to better inform patients on the long-term effects of facial reconstructive surgery on patient satisfaction and quality of life, which are important to improve patient counselling, patient expectation management and shared decision-making.
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Affiliation(s)
- J. Nierich
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E.M.L. Corten
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - T. de Jong
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M.A.M. Mureau
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Talwar AA, Niu EF, Broach RB, Nelson JA, Fischer JP. Patient-reported outcomes: A primer for plastic surgeons. J Plast Reconstr Aesthet Surg 2023; 86:35-47. [PMID: 37688832 DOI: 10.1016/j.bjps.2023.08.008] [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: 03/27/2023] [Revised: 07/23/2023] [Accepted: 08/13/2023] [Indexed: 09/11/2023]
Abstract
Surgical care today is no longer evaluated only on clinical outcomes but also on holistic patient wellbeing. Patient-reported outcomes (PROs) are a representation of the patient's perspective on their results and wellbeing. The aim of this review is to establish PROs as the center of healthcare and plastic surgery, to delineate important PROs in plastic surgery practice and research, to discuss the future of PROs within our discipline, and to encourage surgeons to incorporate PROs into their practice. PROs are an important parallel of clinical outcomes in that they can use the patient's perspective to 1) support clinical findings, 2) detect differences in care when there are no clear clinical differences, 3) track progress longitudinally, and 4) support systemic improvements in healthcare. Plastic surgery as a field is naturally aligned with PROs because, as a discipline, we focus on patient form and function. The emerging forefronts of plastic surgery such as lymphedema care, gender-affirming care, peripheral nerve surgery, migraine surgery, and breast implant illness are critically dependent on PROs. In the next decade, we predict that there will be a continued proliferation of robust PRO measures and integration into healthcare delivery. Outcomes research in surgery should continue to evolve as surgeons provide increasingly more benefits to improve patient wellbeing. Plastic surgeons must continue to play a prominent role in the future of PROs.
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Affiliation(s)
- Ankoor A Talwar
- Division of Plastic Surgery, University of Pennsylvania, United states
| | - Ellen F Niu
- Division of Plastic Surgery, University of Pennsylvania, United states
| | - Robyn B Broach
- Division of Plastic Surgery, University of Pennsylvania, United states
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, United States
| | - John P Fischer
- Division of Plastic Surgery, University of Pennsylvania, United states.
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Kwon JG, Kim Y, Jang MY, Suh HP, Pak CJ, Keeley V, Jeon JY, Hong JP. The Quality of Life after Lymphaticovenous Anastomosis in 118 Lower Limb Lymphedema Patients. Arch Plast Surg 2023; 50:514-522. [PMID: 37808336 PMCID: PMC10556310 DOI: 10.1055/a-2117-4478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/15/2023] [Indexed: 10/10/2023] Open
Abstract
Background This is a prospective study on 118 patients who underwent lymphaticovenous anastomosis (LVA) due to secondary lower limb lymphedema between January 2018 and October 2020 to evaluate patients' quality of life (QOL) using the Quality of Life Measure for Limb Lymphedema (LYMQoL) questionnaire. Methods The outcome measurement included the LYMQoL leg scoring system tool evaluating the function, appearance, symptom, mood, and overall outcome. In addition, correlation analysis was performed for three factors: based on International Society of Lymphology (ISL) stages, disease duration, and amount of volume reduction. Results The LYMQoL tool overall satisfaction score significantly increased at all intervals from 4.4 ± 0.2 preoperative to 6.5 ± 0.3 postoperative at 12 months ( p < 0.001). Significant findings were seen for each domain scores compared preoperatively and at 12 months: function score (18.6 ± 0.5 to 15.4 ± 0.6), appearance score (17.8 ± 0.5 to 16.0 ± 0.6), symptom score (11.8 ± 0.3 to 8.9 ± 0.4), and mood score (14.5 ± 0.4 to 11.4 ± 0.5; p < 0.05). The correlation analysis between improvement of the overall score and the ISL stage ( p = 0.610, correlation coefficient [ r ] = - 0.047), disease duration ( p = 0.659, r = - 0.041), and amount of limb volume reduction ( p = 0.454, r = - 0.070) showed no statistical significance. Conclusion The QOL of secondary lower limb lymphedema patients was significantly improved after LVA regardless of the severity of disease, duration of disease, and amount of volume reduction after LVA. Understanding the patient-reported outcome measurement will help the surgeons to manage and guide the expectations of the patients.
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Affiliation(s)
- Jin Geun Kwon
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeongsong Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Young Jang
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunsuk Peter Suh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Changsik John Pak
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Vaughan Keeley
- Lymphoedema Service, Royal Derby Hospital, Derby, United Kingdom
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Polanco TO, Shamsunder MG, Parikh RP, Chu JJ, McCarthy C, Tadros A, Matros E, Disa JJ, Mehrara BJ, Allen RJ, Nelson JA. Quality of Life in Breast Reconstruction Patients after Irradiation to Tissue Expander: A Propensity-Matched Preliminary Analysis. Plast Reconstr Surg 2023; 152:259-269. [PMID: 36724013 PMCID: PMC10390648 DOI: 10.1097/prs.0000000000010249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tissue expanders (TEs) are routinely placed as a first step in breast reconstruction for women who require postmastectomy radiation therapy (PMRT). The final reconstruction can then be performed with implants or conversion to autologous tissues. The purpose of this study was to compare patient-reported outcomes and surgical complications in autologous (ABR) versus implant-based breast reconstruction (IBR) patients following TE-PMRT. METHODS The authors performed a propensity score preliminary analysis (1:1 matching, no replacement) in patients undergoing ABR or IBR following TE-PMRT. Matched covariates included age, race/ethnicity, smoking status, body mass index, history of psychiatric diagnosis, and laterality of reconstruction. Outcomes of interest included complications and BREAST-Q scores for Satisfaction with Breasts, Physical Well-Being of the Chest, Sexual Well-Being, and Psychosocial Well-Being domains. RESULTS Of 341 patients with TE-PMRT, a total of 106 patients were included in the matched analysis: 53 ABR patients and 53 IBR patients. ABR and IBR did not differ significantly in matched baseline, cancer, and surgical characteristics. ABR patients had higher scores for Satisfaction with Breasts (greater than the four-point minimal clinically important difference) at all postreconstruction time points compared with IBR patients ( P < 0.05). There were no significant postoperative differences in other BREAST-Q domains. The incidence of complications after definitive reconstruction did not differ significantly among cohorts. CONCLUSIONS In this matched preliminary analysis, patients who underwent ABR following irradiation to a TE demonstrated superior satisfaction with breast scores compared with IBR patients. Higher powered matched studies are needed to improve shared decision-making for patients who require mastectomy and PMRT as part of their treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Thais O. Polanco
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meghana G. Shamsunder
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rajiv P. Parikh
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Audree Tadros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J. Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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8
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Kim M, Fong J, Pusic AL, Fischer JP, Mehrara BJ, Nelson JA. Editorial: Maintaining the Integrity of PROMs in Research and Practice. Ann Surg Oncol 2023; 30:3879-3881. [PMID: 37038036 DOI: 10.1245/s10434-023-13394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joline Fong
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham Health, Boston, MA, USA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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9
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Cogliandro A, Salzillo R, Barone M, Tenna S, Cagli B, Persichetti P. Direct-to-Implant Breast Reconstruction After Unilateral and Bilateral Mastectomy: Cross-Sectional Study of Patient Satisfaction and Quality of Life with BREAST-Q. Aesthetic Plast Surg 2023; 47:43-49. [PMID: 35927501 DOI: 10.1007/s00266-022-02986-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/04/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Immediate single stage breast reconstruction is a challenging procedure with the goal of improving the quality of life of patients with breast cancer. The aim of this study is to evaluate using the BREAST-Q patient satisfaction, body perception and quality of life after direct-to-implant breast reconstruction comparing unilateral and bilateral reconstructions. METHODS In this study we enrolled 56 women who underwent mastectomy and immediate single-stage direct-to-implant (DTI) breast reconstruction at Campus Bio-Medico University of Rome between 2013 and 2020. One year after surgery they were administered electronically the BREAST-Q post-operative module. RESULTS Our two cohorts of patients consisted in 34 women who received unilateral nipple-sparing mastectomy and DTI breast reconstruction and 22 women who underwent bilateral nipple-sparing mastectomy and DTI breast reconstruction. Twenty-four of the 34 patients belonging to the unilateral group responded to the questionnaire (70.5%), while in the bilateral group responders were 16 out of 22 (72.7%). The BREAST-Q scores were compared between the two groups: patients undergoing bilateral mastectomy and breast reconstruction showed higher scores in every BREAST-Q domain compared to patients undergoing unilateral mastectomy and breast reconstruction with a statistically significant difference in the Satisfaction with breast (P = 0.01), Sexual well-being (P = 0.03), and Satisfaction with implants (P = 0.01) domains. CONCLUSIONS Patients undergoing bilateral DTI breast reconstruction have a favorable postoperative surgical cosmetic outcome with a better patient's body image perception and a higher post-operative level of satisfaction compared to unilateral DTI reconstruction after nipple-sparing mastectomy. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Annalisa Cogliandro
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus BioVia Alvaro del Portillo 200, Rome, Italy. .,Research group "To be and to appear: Objective indication to Plastic Surgery", Medico University in Rome, Campus Bio, Rome, Italy.
| | - Rosa Salzillo
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus BioVia Alvaro del Portillo 200, Rome, Italy
| | - Mauro Barone
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus BioVia Alvaro del Portillo 200, Rome, Italy.,Research group "To be and to appear: Objective indication to Plastic Surgery", Medico University in Rome, Campus Bio, Rome, Italy
| | - Stefania Tenna
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus BioVia Alvaro del Portillo 200, Rome, Italy
| | - Barbara Cagli
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus BioVia Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus BioVia Alvaro del Portillo 200, Rome, Italy.,Research group "To be and to appear: Objective indication to Plastic Surgery", Medico University in Rome, Campus Bio, Rome, Italy
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10
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Vieira RADC, Bailão-Junior A, de Oliveira-Junior I. Does breast oncoplastic surgery improve quality of life? Front Oncol 2023; 12:1099125. [PMID: 36713564 PMCID: PMC9877289 DOI: 10.3389/fonc.2022.1099125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Breast Oncoplastic Surgery (OS) has established itself as a safe procedure associated with the treatment of breast cancer, but the term is broad, encompassing procedures associated with breast-conserving surgeries (BCS), conservative mastectomies and fat grafting. Surgeons believe that OS is associated with an increase in quality of life (QOL), but the diversity of QOL questionnaires and therapeutic modalities makes it difficult to assess from the patient's perspective. To answer this question, we performed a search for systematic reviews on QOL associated with different COM procedures, and in their absence, we selected case-control studies, discussing the main results. We observed that: (1) Patients undergoing BCS or breast reconstruction have improved QoL compared to those undergoing mastectomy; (2) In patients undergoing BCS, OS has not yet shown an improvement in QOL, a fact possibly influenced by patient selection bias; (3) In patients undergoing mastectomy with reconstruction, the QoL results are superior when the reconstruction is performed with autologous flaps and when the areola is preserved; (4) Prepectoral implants improves QOL in relation to subpectoral implant-based breast reconstruction; (5) ADM do not improves QOL; (6) In patients undergoing prophylactic mastectomy, satisfaction is high with the indication, but the patient must be informed about the potential complications associated with the procedure; (7) Satisfaction is high after performing fat grafting. It is observed that, in general, OS increases QOL, and when evaluating the procedures, any preservation or repair, or the use of autologous tissues, increases QOL, justifying OS.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos/SP, Brazil,Departamento de Cirurgia Oncológica, Divisão de Mastologia, Hospital de Câncer de Muriaé, Muriaé/MG, Brazil,Active Member of European Organisation for Research and Treatment (EORTC) Quality of life Group, Brussels, Belgium,*Correspondence: René Aloisio da Costa Vieira,
| | - Antônio Bailão-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos/SP, Brazil
| | - Idam de Oliveira-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos/SP, Brazil,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos/SP, Brazil
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11
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Nelson JA, Cordeiro PG, Polanco T, Shamsunder MG, Patel A, Allen RJ, Matros E, Disa JJ, Cuaron JJ, Morrow M, Mehrara BJ, Pusic AL, McCarthy CM. Association of Radiation Timing with Long-Term Satisfaction and Health-Related Quality of Life in Prosthetic Breast Reconstruction. Plast Reconstr Surg 2022; 150:32e-41e. [PMID: 35499580 DOI: 10.1097/prs.0000000000009180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radiation therapy is increasingly used after breast cancer surgery, which may impact patients' postoperative quality of life. This study assessed differences in long-term patient satisfaction and health-related quality of life after radiation therapy administered at different stages of implant-based breast reconstruction or with no radiation after surgery. METHODS In this observational study, long-term outcomes were evaluated for four cohorts of women who completed breast reconstruction and received (1) no radiation, (2) radiation before tissue expander placement, (3) radiation after tissue expander placement, or (4) radiation after permanent implant between 2010 and 2017 at Memorial Sloan Kettering. Satisfaction and health-related quality of life were assessed using the prospectively collected Satisfaction with Breasts and Physical Well-Being of Chest BREAST-Q subscales. Score distributions were examined by radiation exposure status for 3 years after surgery using nonparametric analyses and regression models. RESULTS Of 2932 patients who met the inclusion criteria, 25.8 percent received radiation during breast cancer treatment, including before tissue expander placement ( n = 239; 8.2 percent), after tissue expander placement ( n = 290; 9.9 percent), and after implant placement ( n = 228; 7.8 percent). Radiotherapy patients had average scores 7 to 9 points lower at all postoperative time points for Satisfaction with Breasts and Physical Well-Being of Chest subscales ( p < 0.001). Although patient-reported outcomes did not differ by radiation timing, there were higher rates of severe capsular contracture with postimplant radiotherapy ( p < 0.001). CONCLUSIONS Radiation therapy significantly affected patient satisfaction and health-related quality of life following implant breast reconstruction through 3 years postoperatively. Patient perception of outcome was unaffected by radiotherapy timing; however, capsular contracture was higher after postimplant radiotherapy, suggesting there may be an advantage to performing radiotherapy before placement of the final reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Jonas A Nelson
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Peter G Cordeiro
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Thais Polanco
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Meghana G Shamsunder
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Aadit Patel
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Robert J Allen
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Evan Matros
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Joseph J Disa
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - John J Cuaron
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Monica Morrow
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Babak J Mehrara
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Andrea L Pusic
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Colleen M McCarthy
- From the Plastic and Reconstructive Surgery Service and Breast Surgery Service, Department of Surgery, and Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
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12
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Blohmer JU, Beier L, Faridi A, Ankel C, Krause-Bergmann B, Paepke S, Mau C, Keller M, Strittmatter HJ, Karsten MM. Patient-Reported Outcomes and Aesthetic Results after Immediate Breast Reconstruction Using Human Acellular Dermal Matrices: Results of a Multicenter, Prospective, Observational NOGGO-AWOGyn Study. Breast Care (Basel) 2021; 16:335-342. [PMID: 34594165 PMCID: PMC8436721 DOI: 10.1159/000509568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the increased use of acellular dermal matrices (ADMs) in implant-based breast reconstructions (IBBRs), the evaluation of patient-reported outcomes becomes more important. METHODS Patients who underwent an immediate human ADM-assisted, submuscular IBBR were included in this noninterventional, multicenter, prospective cohort study. Patients with primary reconstruction (cohort A) and patients with a revision surgery after capsular fibrosis (cohort B) were followed up for 12 months after surgery. Quality of life (EORTC BR-23) and patient and surgeon satisfaction scores (1 ["very satisfied"] to 6 ["not satisfied"]) with the outcome and the aesthetic result evaluated by 2 independent, external experts were assessed. RESULTS Eighty-four patients were enrolled in the study. The mean patient satisfaction score was 2.1 ± 0.8, with higher satisfaction in cohort B (p = 0.041). The score did not change significantly during the follow-up (p = 0.479). The mean satisfaction score of the surgeons was 2.0 ± 0.7; it was also higher in cohort B (p = 0.016) and showed no changes over time (p = 0.473). The mean aesthetic result was 2.2 ± 0.7. 92.9% of the patients completed at least 1 quality of life questionnaire. Body image and sexual functioning increased during follow-up. One year after surgery, the mean scores were 77.2 ± 22.5 and 44.7 ± 27.3, respectively. CONCLUSION The level of satisfaction among patients and surgeons and the score of the aesthetic result were constantly high among patients after ADM-assisted IBBR. Higher satisfaction scores could be observed after revision surgery caused by capsular fibrosis (cohort B) compared to primary reconstruction (cohort A). Quality of life increased during the first year after surgery.
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Affiliation(s)
- Jens-Uwe Blohmer
- Gynecology and Breast Center, Charité − Universitätsmedizin Berlin, Berlin, Germany
- AWOGyn, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Lea Beier
- Gynecology and Breast Center, Charité − Universitätsmedizin Berlin, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Andree Faridi
- AWOGyn, Berlin, Germany
- Senology and Breast Center, University Hospital Bonn, Bonn, Germany
| | | | | | - Stefan Paepke
- AWOGyn, Berlin, Germany
- Brustzentrum der Technischen Universität München Klinikum Rechts der Isar Comprehensive Cancer Center, Munich, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Christine Mau
- Breast Center, Department of Gynecology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Maren Keller
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Hans Joachim Strittmatter
- AWOGyn, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
- Department of Gynecology, Rems-Murr-Hospital Winnenden, Winnenden, Germany
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13
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Safety of a Modified Lipoabdominoplasty Technique for Donor-Site Closure in Abdominal-Based Free Flap Breast Reconstruction. Aesthetic Plast Surg 2021; 45:1431-1440. [PMID: 33483783 DOI: 10.1007/s00266-020-02117-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/26/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aesthetic and functional outcomes of the donor site following abdominal-based free flap breast reconstruction have been suboptimal. The objective of this study is to evaluate a modified liposuction-assisted abdominoplasty technique combined with rectus plication (LPARSP) adopted from cosmetic abdominoplasty practice. PATIENTS AND METHODS All abdominal-based free flap breast reconstructions from 01/2017 to 03/2019 were reviewed. Patients with central fullness and sufficient tissue surplus on the abdomen, thighs and flanks who received LPARSP and rectus plication were identified (LPARSP group) and matched for age and body mass index with patients who underwent conventional abdominoplasty (CA group). Abdominal skin sensation, objective functional and aesthetic measures of the abdomen, as well as patient-reported outcomes (Breast-Q), were analyzed. RESULTS A total of 28 patients were included. Groups were similar in demographics. The mean amount of lipoaspirate in the LPARSP group was 1054±613.5 ml. The postoperative course was similar in both groups. The LPARSP technique resulted in a lower positioned horizontal scar (p = 0.03). The aesthetic outcome was superior in the LPARSP group (p < 0.0001). Furthermore, the LPARSP group presented with a decreased bulging rate (p = 0.05), and secondary refinement procedures were less frequently demanded (p = 0.02). In addition, the abdominal wall sensation of the flanks was improved in the LPARSP group (p = 0.05), whereby patient-reported outcome measures did not differ between groups. CONCLUSIONS Lipoabdominoplasty with rectus plication represents a safe approach for donor-site closure in selected patients undergoing abdominal-based free flap breast reconstruction. Superior functional and aesthetic results paired with improved abdominal wall sensation are achieved compared to CA. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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14
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Farley ES, Amirtharajah M, Winters RD, Taiwo AO, Oyemakinde MJ, Fotso A, Torhee LA, Mehta UC, Bil KA, Lenglet AD. Outcomes at 18 mo of 37 noma (cancrum oris) cases surgically treated at the Noma Children's Hospital, Sokoto, Nigeria. Trans R Soc Trop Med Hyg 2021; 114:812-819. [PMID: 32785671 PMCID: PMC7645286 DOI: 10.1093/trstmh/traa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/17/2020] [Accepted: 07/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background Noma is a rapidly progressing infection of the oral cavity frequently resulting in severe facial disfigurement. We present a case series of noma patients surgically treated in northwest Nigeria. Methods A retrospective analysis of routinely collected data (demographics, diagnosis and surgical procedures undergone) and in-person follow-up assessments (anthropometry, mouth opening and quality of life measurements) were conducted with patients who had surgery >6 mo prior to data collection. Results Of the 37 patients included, 21 (56.8%) were male and 22 (62.9%) were aged >6 y. The median number of months between last surgery and follow-up was 18 (IQR 13, 25) mo. At admission, the most severely affected anatomical area was the outer cheek (n = 9; 36.0% of patients had lost between 26% and 50%). The most frequent surgical procedures were the deltopectoral flap (n = 16; 43.2%) and trismus release (n = 12; 32.4%). For the eight trismus-release patients where mouth opening was documented at admission, all had a mouth opening of 0–20 mm at follow-up. All patients reported that the surgery had improved their quality of life. Conclusions Following their last surgical intervention, noma patients do experience some improvements in their quality of life, but debilitating long-term sequelae persist.
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Affiliation(s)
- Elise S Farley
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria.,Department of Public Health Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | | | - Ryan D Winters
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, LA, USA
| | - Abdurrazaq O Taiwo
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.,Faculty of Dental Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | | | - Linda A Torhee
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
| | - Ushma C Mehta
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Karla A Bil
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Annick D Lenglet
- Médecins Sans Frontières, Amsterdam, the Netherlands.,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
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15
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Nelson JA, Polanco TO, Shamsunder MG, Coriddi M, Matros E, Hicks MEV, Disa JJ, Mehrara BJ, Allen RJ, Dayan JH, Afonso A. Perioperative Inpatient Opioid Consumption Following Autologous Free-Flap Breast Reconstruction Patients: An Examination of Risk and Patient-Reported Outcomes. Ann Surg Oncol 2021; 28:7823-7833. [PMID: 33959829 DOI: 10.1245/s10434-021-10023-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The response to the unprecedented opioid crisis in the US has increased focus on multimodal pain regimens and enhanced recovery after surgery (ERAS) pathways to reduce opioid use. This study aimed to define patient and system-level factors related to perioperative consumption of opioids in autologous free-flap breast reconstruction. METHODS We conducted a retrospective study to identify patients who underwent autologous breast reconstruction between 2010 and 2016. A multivariate linear regression model was developed to assess patient and system-level factors influencing opioid consumption. Opioid consumption was then dichotomized as total postoperative opioid consumption above (high) and below (low) the 50th percentile to afford more in-depth interpretation of the regression analysis. Secondary outcome analyses examined postoperative complications and health-related quality-of-life outcomes using the BREAST-Q. RESULTS Overall, 601 patients were included in the analysis. Unilateral reconstruction, lower body mass index, older age, and administration of ketorolac and liposomal bupivacaine were associated with lower postoperative opioid consumption. In contrast, history of psychiatric diagnoses was associated with higher postoperative opioid consumption. There was no difference in the rates of postoperative complications when comparing the groups, although patients who had lower postoperative opioid consumption had higher BREAST-Q physical well-being scores. CONCLUSION System-level components of ERAS pathways may reduce opioid use following autologous breast reconstruction, but surgical and patient factors may increase opioid requirements in certain patients. ERAS programs including liposomal bupivacaine and ketorolac should be established on a system level in conjunction with continued focus on individualized care, particularly for patients at risk for high opioid consumption.
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Affiliation(s)
- Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Thais O Polanco
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghana G Shamsunder
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Joseph J Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph H Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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16
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Seventy-Fifth Anniversary of Plastic and Reconstructive Surgery: How Evidence-Based Medicine Has Transformed Plastic Surgery. Plast Reconstr Surg 2021; 147:1235-1241. [PMID: 33890912 DOI: 10.1097/prs.0000000000007913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Salgarello M, Pagliara D, Barone Adesi L, Visconti G, Wild JB, Matey P. Direct to Implant Breast Reconstruction With Prepectoral Micropolyurethane Foam-Coated Implant: Analysis of Patient Satisfaction. Clin Breast Cancer 2021; 21:e454-e461. [PMID: 33627298 DOI: 10.1016/j.clbc.2021.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Immediate implant reconstruction after mastectomy with submuscular implant placement is widely used in order to avoid implant exposure, capsular contracture and poor aesthetic result. Postoperative complications can be reduced by maintain mastectomy flap thickness and asses flap vascularity with near infrared imaging. The prepectoral reconstruction with polyurethane implants has been utilized with encouraging results. Postoperative patient satisfaction was assessed with the BREAST-Q scores in patients who underwent prepectoral reconstruction with polyurethane implants. Additionally the impact of mastectomy flap thickness on breast reconstruction was investigated. MATERIALS AND METHODS The Breast Q-scores of satisfaction with the breast, the postoperative outcome and physical well-being of the chest in 70 patients underwent immediate implant breast reconstructions with prepectoral polyurethane implant were retrospectively reviewed. The correlation between mastectomy flap thickness and satisfaction with breast was analyzed. RESULTS At 12-month follow-up the mean Q-score for satisfaction with breast was 71.73 (standard deviation: 13.31), and for physical well-being chest was 70.73 (standard deviation: 7.94). A positive linear correlation between mastectomy flap thickness and satisfaction with the breast was identified. CONCLUSIONS The postoperative Q-scores are encouraging in the use of polyurethane prepectoral implants in immediate breast reconstruction, especially in patients with "thick" mastectomy flaps.
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Affiliation(s)
- Marzia Salgarello
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Chirurgia Plastica, Largo Francesco Vito 1, 00168 Roma, Italy
| | - Domenico Pagliara
- Mater Olbia Hospital, Strada Statale 125 Orientale Sarda, 07026 Olbia (SS), Italy.
| | - Liliana Barone Adesi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Chirurgia Plastica, Largo Francesco Vito 1, 00168 Roma, Italy
| | - Giuseppe Visconti
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Chirurgia Plastica, Largo Francesco Vito 1, 00168 Roma, Italy
| | | | - Pilar Matey
- New Cross Hospital, Royal Wolverhampton Trust, Wolverhampton, UK
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18
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Tan YY, Chin YR, Bajaj K, Thomas S. Patient-reported outcomes for nipple reconstruction: Review of literature. Surgeon 2021; 19:e245-e255. [PMID: 33423920 DOI: 10.1016/j.surge.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/04/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is currently no validated patient-reported outcome measure (PROM) that is specific to nipple-areola complex (NAC) reconstruction. This paper evaluates all patient-reported outcomes for NAC reconstruction in the literature. METHODS Systematic literature searches of The Cochrane Central Register of Controlled Trials, MEDLINE and World Health Organization International Clinical Trials Registry Platform were conducted to identify all primary studies with patient-reported outcomes for NAC reconstruction. The primary outcome measures were patient satisfaction rates for appearance and symmetry of NAC reconstruction. RESULTS Fifty-nine papers were included in this review. Reported patient satisfaction was generally high, with the pooled average satisfaction rate for appearance being 81.9% and symmetry 80.3%. 89.5% of respondents would do it again and 94.8% would recommend it to others. There is no standardised or validated PROM specific to NAC reconstruction and this contributes to a lack of conclusive findings from studies in this area. CONCLUSION There is a need for a validated PROM that is specific to NAC reconstruction, in order to serve as a standardised outcome assessment to guide further research and improve patient care.
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Affiliation(s)
- Yan Yu Tan
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
| | - Ye Ru Chin
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Kuljyot Bajaj
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Sunil Thomas
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
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19
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Bascarane S, Kuppili PP, Menon V. Psychiatric Assessment and Management of Clients Undergoing Cosmetic Surgery: Overview and Need for an Integrated Approach. Indian J Plast Surg 2021; 54:8-19. [PMID: 33854274 PMCID: PMC8034989 DOI: 10.1055/s-0040-1721868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Psychiatric disorders are more common among people undergoing cosmetic procedures than the general population and evaluating mental health can be cumbersome for plastic surgeons. We aim to summarize the available literature in this regard and propose an integrated approach to psychiatric assessment and management of mental health issues among this group. Methods Electronic search of MEDLINE, Google Scholar, and PsycINFO databases was done to identify relevant peer-reviewed English language articles from inception till April 2020. Generated abstracts were screened for their eligibility. Included articles were grouped according to their thematic focus under the following headings; prevalence of psychiatric morbidity among clients posted for cosmetic surgery, assessment tools, and management of psychiatric morbidity in relation to undergoing cosmetic surgery. Results A total of 120 articles were reviewed. The prevalence of psychiatric disorder in patients undergoing cosmetic surgery was 4 to 57% for body dysmorphic disorder (BDD); the corresponding figures for depression, anxiety, and personality disorder were 4.8 to 25.8, 10.8 to 22, and 0 to 53%, respectively. A range of tools have been used to assess these disorders and specific measures are also available to assess clinical outcomes following surgery. Screening for these disorders is essential to prevent unnecessary surgical procedures, as well as to ensure timely management of the psychiatric comorbidity. Conclusion Psychiatric morbidity is a common concomitant in cosmetic surgery. A structured and integrated approach to evaluation and management of psychiatric morbidity will help to optimize postsurgical outcomes.
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Affiliation(s)
- Sharmi Bascarane
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pooja P. Kuppili
- Senior Clinical Fellow, Penn Hospital Black Country Healthcare NHS Foundation Trust United Kingdom
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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20
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Rindom MB, Gunnarsson GL, Lautrup MD, Tos T, Hölmich PLR, Sørensen PJA, Thomsen JB. Good health-related quality-of-life and high patient-reported satisfaction after delayed breast reconstruction with pedicled flaps from the back. J Plast Reconstr Aesthet Surg 2020; 74:1752-1757. [PMID: 33676866 DOI: 10.1016/j.bjps.2020.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This paper presents the results of a randomized controlled trial (RCT) that focus on health-related quality-of-life (QoL) and patient-reported satisfaction following breast reconstruction with pedicled flaps from the back. MATERIALS & METHODS We included women for unilateral delayed breast reconstruction. Patients were randomized to reconstruction by either a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TAP) flap. Assessment of QoL and patient satisfaction was made using two different patient-reported outcome measures (PROMs): The EORTC QLQ-30 and the Breast-Q questionnaire for post-mastectomy breast reconstruction. RESULTS A total of 50 women were enrolled over a two-year period and allocated to reconstruction. Forty patients completed both surgery and follow-up and were included in the analysis - 18 in the LD group and 22 in the TAP group. The EORTC QLQ-30 was administered at the baseline and at one-year follow-up. There was no significant effect of introducing the TAP flap on either the summary score, the global QoL-score or the financial impact-score when compared to the LD flap. The Breast-Q questionnaire was administered only at one-year follow-up. There was no significant difference between the two groups for the scores for satisfaction with the reconstructed breast, the overall outcome and QoL related to psycho-social, sexual and physical well-being. CONCLUSION Women from both groups report high satisfaction and QoL following the reconstruction. The quality of the dataset and the study design are, however, insufficient to rule out any existing difference. A larger cohort, longer follow-up and different design are warranted to assess the true clinical significance these reconstructions might have on satisfaction and QoL.
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Affiliation(s)
- Mikkel Børsen Rindom
- Department of Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | | | | | - Tina Tos
- Department of Plastic Surgery, Herlev & Gentofte Hospital, Herlev, Denmark
| | | | | | - Jørn B Thomsen
- Department of Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark; Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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21
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Abstract
BACKGROUND Labiaplasty has grown in popularity, but it remains controversial. Few studies have quantified the change in specific symptomatology from before to after labiaplasty to establish its effectiveness in improving quality of life. METHODS In a prospective study, 62 patients undergoing labiaplasty completed written surveys privately in an examination room preoperatively and postoperatively about the presence of 11 physical and appearance-related symptoms. RESULTS Mean patient age was 33.5 years (range, 17 to 61 years). Two patients were of minority age. All patients presented with at least one symptom, averaging 6.5 (range, one to 11). Most (82.2 percent) had a trim labiaplasty, and the rest (17.7 percent) had a wedge. After labiaplasty, 93.5 percent of patients were symptom-free, with the average dropping to 0.23 of 11 symptoms. Symptom-prevalence changes from preoperatively to postoperatively included self-consciousness, dropping from 93 percent to 6.5 percent; tugging (from 66.1 percent to 0 percent); feeling less attractive (from 66.1 percent to 0 percent); negative impact on self-esteem (from 64.5 percent to 1.6 percent); negative impact on intimacy (from 62.5 percent to 0 percent); twisting (from 58.1 percent to 3.2 percent); being uncomfortable (from 56.5 percent to 4.8 percent); clothing restriction (from 54.8 percent to 3.2 percent); visible outline (from 46.8 percent to 1.6 percent); pain (from 43.5 percent to 1.6 percent); and exposure in swimsuits (from 38.7 percent to 1.6 percent). No major complications occurred. Two patients felt their labia were still too long and revision was offered. Average follow-up was 13.3 months (range, 6 to 24 months). CONCLUSIONS Patients with elongated labia have a high incidence of functional and appearance-related symptoms. Labiaplasty is a safe procedure that yields significant improvement in quality of life. CLINICAL QUESTIONS/LEVEL OF EVIDENCE Therapeutic, IV.
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Stability of Long-Term Outcomes in Implant-Based Breast Reconstruction: An Evaluation of 12-Year Surgeon- and Patient-Reported Outcomes in 3489 Nonirradiated and Irradiated Implants. Plast Reconstr Surg 2020; 146:474-484. [PMID: 32842095 DOI: 10.1097/prs.0000000000007117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outcomes following prosthetic breast reconstruction have been well studied. However, the majority of studies are limited by short-term follow-up and a lack of aesthetic and patient-reported outcomes. This study objectively examines long-term surgeon- and patient-reported outcomes following two-stage prosthetic breast reconstruction. METHODS Consecutive patients undergoing two-stage prosthetic breast reconstruction from 1994 to 2016 performed by the senior author (P.G.C.), with at least 1-year follow-up after implant exchange, were reviewed retrospectively. Long-term surgeon-reported outcomes, including aesthetic and capsular contracture scores, and patient-reported outcomes using the BREAST-Q, were recorded at each outpatient visit and analyzed over the 12-year follow-up period. RESULTS Retrospective review revealed 2284 patients, or 3489 breasts, that fit the inclusion criteria. Aesthetic scores and capsular contracture rates remained stable over the entire follow-up period. Subset analysis demonstrated that bilateral and nonirradiated reconstructions consistently had the highest aesthetic scores, whereas unilateral irradiated breasts had the lowest. Irradiated breasts consistently had high rates of capsular contracture, although the extent of contracture improved over time in all patients. Patient-reported BREAST-Q scores showed either stability or improvement over time in all patients. Irradiated and nonirradiated patients demonstrated comparable long-term satisfaction with outcomes despite significant differences in satisfaction with their breasts. CONCLUSIONS The authors' study, the largest of its kind, demonstrates that prosthetic breast reconstruction outcomes do not deteriorate over time. This stability is apparent in both long-term surgeon- and patient-reported outcomes data measured in the same patients. These results contradict the surgical dogma surrounding prosthetic breast reconstruction and therefore should be given significant consideration when counseling patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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The added value of immediate breast reconstruction to health-related quality of life of breast cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1848-1853. [PMID: 32763107 DOI: 10.1016/j.ejso.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Postmastectomy immediate breast reconstruction (IBR) may improve the quality of life (QoL) of breast cancer patients. Guidelines recommend to discuss the option IBR with all patients undergoing mastectomy. However, substantial hospital variation in IBR-rates was previously observed in the Netherlands, influenced by patient, tumour and hospital factors and clinicians' believes. Information provision about IBR may have a positive effect on receiving IBR and therefore QoL. This study investigated patient-reported QoL of patients treated with mastectomy with and without IBR. METHODS An online survey, encompassing the validated BREAST-Q questionnaire, was distributed to a representative sample of 1218 breast cancer patients treated with mastectomy. BREAST-Q scores were compared between patients who had undergone mastectomy either with or without IBR. RESULTS A total of 445 patients were included for analyses: 281 patients with and 164 without IBR. Patients who had received IBR showed significantly higher BREAST-Q scores on "psychosocial well-being" (75 versus 67, p < 0.001), "sexual well-being" (62 versus 52, p < 0.001) and "physical well-being" (77 versus 74, p = 0.021) compared to patients without IBR. No statistically significant difference was found for "satisfaction with breasts" (64 versus 62, p = 0.21). Similar results were found after multivariate regression analyses, revealing IBR to be an independent factor for a better patient-reported QoL. CONCLUSIONS Patients diagnosed with breast cancer with IBR following mastectomy report a better QoL on important psychosocial, sexual and physical well-being domains. This further supports the recommendation to discuss the option of IBR with all patients with an indication for mastectomy and to enable shared decision-making.
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Sorice-Virk S, Li AY, Canales FL, Furnas HJ. The Role of Pornography, Physical Symptoms, and Appearance in Labiaplasty Interest. Aesthet Surg J 2020; 40:876-883. [PMID: 31556940 DOI: 10.1093/asj/sjz254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With the American College of Obstetricians and Gynecologists reaffirming its 2007 opposition to labiaplasty in 2019, the procedure continues to be controversial. Particular emphasis on pornography as a major influencer on women seeking labiaplasty contributes to its controversy and distracts from other motivations. Few articles have established pornography's influence relative to functional and appearance-related symptoms. OBJECTIVES The objective of this study was to investigate the relative influence of pornography on women's decision to seek labiaplasty relative to other factors compared with a control cohort. METHODS In this prospective study, 124 consecutive patients consulting about labiaplasty and a control cohort of 50 women were questioned about 11 labia-related symptoms and the possible influence of pornography. RESULTS The mean age was 34.2 and 38.9 years in the labiaplasty and control cohorts, respectively. Women in the labiaplasty cohort had on average 2.8 of the 6 queried physical symptoms and 3.2 of the 5 queried appearance-related symptoms compared with control patients who reported an average of 0.3 of the 6 queried physical symptoms and 0.2 of the 5 queried appearance-related symptoms (P < 0.001). Less than one-half (47% of the labiaplasty and 42% of the control cohort) never viewed pornography. Pornography was not an influential factor to seek labiaplasty in 42% of the labiaplasty cohort and 54% of the control cohort. A minority (11% in the labiaplasty cohort and 4% in the control cohort) said that pornography influenced them to seek labiaplasty. There were no statistically significant differences between these 2 groups. CONCLUSION Pornography influences some women to seek labiaplasty, but relative to other motivating factors its role is minor.
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Affiliation(s)
- Sarah Sorice-Virk
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Alexander Y Li
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, CA
| | | | - Heather J Furnas
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, CA
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Denadai R, Lo LJ. Building a virtuous cycle of surgical cleft-craniofacial care by combining surgeon centered outcome and patient reported outcome measures. J Plast Reconstr Aesthet Surg 2020; 73:1174-1205. [PMID: 32113961 DOI: 10.1016/j.bjps.2020.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/17/2020] [Accepted: 02/08/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil.
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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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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Gadkaree SK, Shaye DA, Occhiogrosso J, Lee LN. Association Between Pain and Patient Satisfaction After Rhinoplasty. JAMA FACIAL PLAST SU 2020; 21:475-479. [PMID: 31536105 DOI: 10.1001/jamafacial.2019.0808] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Importance In light of the current opioid crisis, there exists a demonstrated need to balance adequate postrhinoplasty pain control with measured use of narcotics. If pain is inadequately controlled, patients may be unsatisfied with their elective surgical experience. Objectives To characterize the association between patient-reported pain outcomes, objective opioid use, and perception of surgical success. Design, Setting, and Participants A case series survey study was conducted from July 2018 to January 2019. Consecutive patients who underwent cosmetic and/or functional rhinoplasty by 2 facial plastic surgeons (D.A.S. and L.N.L.) at an academic medical center were surveyed 1 month after surgery. Main Outcomes and Measures The number of oxycodone tablets taken, patient-reported pain outcomes, number of narcotic prescription refills, and patient-reported functional and cosmetic outcomes were recorded. Perception of pain, surgical outcome, and oxycodone intake were also evaluated by sex. Demographic information and perception of surgical results were recorded. Statistical analysis was performed using STATA statistical software (version 12.0, STATA Corp). Spearman rank order correlation was used for ordinal, monotonic variables with P < .05 being considered statistically significant. Results Overall, 104 patients were surveyed; 6 were lost to follow-up. Of the participants included, 50 were women with a mean (SD) age of 38 (16.0) years and 48 were men with a mean (SD) age of 38 (16.7) years. Although patients were prescribed a range of 10 to 40 tablets of oxycodone, patients took a mean (SD) of 5.2 tablets (range, 0-23). There were no significant sex differences in perception of pain, perception of outcome, or narcotic use. Among patients undergoing purely functional rhinoplasty, a statistically significant negative association between perception of pain and perception of functional outcome (breathing improvement) was evident. Patients who experienced less pain than they expected had a greater perception of functional improvement (rs = -0.62, P = .001). In contrast, among patients who underwent rhinoplasty with cosmetic improvement, no association was found between pain and perception of surgical outcome (rs = 0.05, P = .64). Conclusions and Relevance To our knowledge, this is the first study to prospectively evaluate the association between opioid use, patient-reported pain, and perceived surgical success. These data may help guide preoperative counseling because patients who are interested purely in breathing improvement (without cosmetic change) may warrant additional pain-specific counseling to optimize patient satisfaction. Level of Evidence 3.
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Affiliation(s)
- Shekhar K Gadkaree
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - David A Shaye
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Jessica Occhiogrosso
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Linda N Lee
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
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Patient-reported Aesthetic Satisfaction following Facial Skin Cancer Surgery Using the FACE-Q Skin Cancer Module. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2423. [PMID: 31942391 PMCID: PMC6908379 DOI: 10.1097/gox.0000000000002423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/02/2019] [Indexed: 11/25/2022]
Abstract
Over 5 million basal and squamous cell skin cancers are diagnosed each year. Seventy to 80% of these cancers occur in the head and neck region, for which surgical excision is the standard treatment. As patient satisfaction and quality of life are among the most important outcomes in plastic and reconstructive surgery, understanding patient perception of aesthetic postoperative outcome is critical. The objective of this study was to assess aesthetic satisfaction following facial skin cancer surgery using the FACE-Q Skin Cancer Module in the context of sociodemographic and clinical factors. Methods This is a single-center, cross-sectional study in a tertiary care cancer setting of patients who underwent facial skin cancer surgery from March 1, 2016, to March 31, 2018. Patients completed the FACE-Q Skin Cancer Satisfaction with Facial Appearance and Appraisal of Scar scales postoperatively, between May 21, 2018, and October 1, 2018. Results Patients completed the Satisfaction with Facial Appearance (n = 405) and Appraisal of Scar scales (n = 408) postoperatively (response rate 39%). Lower postoperative facial appearance and scar satisfaction scores were associated with female gender, younger age (<65 years), surgery location on the lip or nose, repair by flap or graft, and greater defect size. Linear regression models established that younger age, female gender, nose location, and flap repair were independently predictive of lower aesthetic satisfaction. Conclusions Sociodemographic factors, central facial location, and repair type strongly contribute to aesthetic satisfaction following facial skin cancer surgery. This patient-reported data may guide counseling regarding postoperative aesthetic outcome and inform patient expectations.
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Cordova LZ, Hunter-Smith DJ, Rozen WM. Patient reported outcome measures (PROMs) following mastectomy with breast reconstruction or without reconstruction: a systematic review. Gland Surg 2019; 8:441-451. [PMID: 31538070 DOI: 10.21037/gs.2019.07.02] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The cornerstone of reconstructive surgery following mastectomy is to restore cosmesis and improve physical and psychological health. Consequently, it has become essential for instruments that measure surgical outcomes to include the direct perspective of patients. Many reviews have failed to show significant improvements in quality of life domains following breast reconstruction compared to mastectomy alone. However, with advances in surgical techniques and patient reported outcome measure (PROM) assessment tools designed precisely for breast reconstruction patients, a modern systematic review is warranted. An electronic literature review was performed using CINAHL, Cochrane Library and Medline (using PubMed) comparing patient reported outcome measures of patients undergoing mastectomy alone versus patients undergoing mastectomy with breast reconstruction. Studies in the English and Portuguese languages since the year 2000 were included. The review was undertaken adhering to PRISMA guidelines with last entry on the 31/5/2018. Full text review yield 42 articles of relevance to the inclusion criteria. The most widely used PROM instruments such as Breast-Q, EORTC-Q30/Q23, Short Form 36, FACT-B and others are explored. The specific difficulties conducting such studies and biases identified are investigated further. Studies comparing mastectomy alone against mastectomy with reconstruction show difficulties forming groups with similar clinical and epidemiological characteristics. There are inherent limitations to performing a randomised controlled trial on this topic, including matching patient groups in terms of age, socioeconomical background and cancer staging, and this affects the results of the PROM instruments. Within these limitations, the literature suggests that PROM support the use of breast reconstruction following mastectomy but care must be made selecting patients. The finding is supported by the National Institute for Health and Clinical Excellence (NICE) guidelines which state that breast reconstruction should be offered to all women undergoing breast cancer surgery.
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Affiliation(s)
- Leonardo Z Cordova
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Australia.,Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Australia
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Australia.,Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Australia
| | - Warren M Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Australia.,Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Australia
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A Systematic Review of Outcomes After Genital Lymphedema Surgery: Microsurgical Reconstruction Versus Excisional Procedures. Ann Plast Surg 2019; 83:e85-e91. [PMID: 31135508 DOI: 10.1097/sap.0000000000001875] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Genital lymphedema (GL) surgery can be either palliative or functional. Palliative procedures involve excision of the affected tissue and reconstruction by either local flaps or skin grafts. Reconstructive procedures aim to restore lymphatic flow through microsurgical lymphaticovenous anastomoses (LVAs). This systematic analysis of outcomes and complication rates aims to compare outcomes between these surgical treatment options for GL. METHODS A systematic review of the PubMed database was performed with the following search algorithm: (lymphorrhea or lymphedema) and (genital or scrotal or vulvar) and (microsurgery or "surgical treatment"), evaluating outcomes, and complications after surgical treatment of GL. RESULTS Twenty studies published between 1980 and 2016 met the inclusion criteria (total, 151 patients). Three main surgical treatments for GL were identified. Surgical resection and primary closure or skin graft was the most common procedure (46.4%) with a total complication rate of 10%. Surgical resection and flap reconstruction accounted for 39.1% of the procedures with an overall complication rate of 54.2%. Lympho venous shunt (LVA) procedures (14.5%) had a total complication rate of 9%. CONCLUSIONS This review demonstrates a lack of consensus in both the preoperative assessment and surgical management of GL. Patients receiving excisional procedures tended to be later stage lymphedema. Patients in the excision and flap reconstruction group seemed to have the highest complication rates. Microsurgical LVAs may represent an alternative approach to GL, either alone or in combination with traditional procedures.
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Effectiveness and safety of the use of gracilis muscle for dynamic smile restoration in facial paralysis: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019; 72:1254-1264. [PMID: 31204152 DOI: 10.1016/j.bjps.2019.05.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/16/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Smiling is a fundamental component of social interactions. Significant challenges arise for patients with facial palsy. One of the key procedures for dynamic smile restoration is the microneurovascular transfer of a gracilis muscle. We aimed to assess the effectiveness and safety of dynamic smile reanimation surgery using the free gracilis muscle unit in patients with facial palsy. METHODS We conducted a systematic review and meta-analysis of studies reporting surgical outcomes of dynamic smile restoration using free gracilis muscles identified from EMBASE, Medline, and Web of Science databases from their inception to March 15, 2018. Two-stage screening and data extraction were performed by two independent reviewers. Pooled proportions were calculated using random-effects models. RESULTS Thirty-one studies including 1647 patients who underwent 1739 free gracilis flaps were included. Twelve (38.7%) studies measured perioperative smile excursion change using six different tools. Six of these studies were homogeneous and were used in meta-analyses of smile excursion improvement, which revealed a mean change of 7.5 mm (95% CI 6.0-9.0 mm, I2 86.7%) perioperatively. Twenty (64.5%) studies reported perioperative complications, and pooled proportions of flap failures were of 2.9% (95% CI 1.3-4.5%, I2 47.7%). CONCLUSIONS Dynamic smile restoration using a free gracilis muscle may represent an effective procedure to regain oral commissure motion and is associated with an approximately 3% rate of flap failure. Masseteric nerve coaptations lead to larger improvements in perioperative smile excursion (10 mm) than cross-facial nerve grafts (6.8 mm). Future studies with homogeneous reporting of smile excursion and patient-reported outcome measures are needed.
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Bressmann T, Eick T, Pardo J. Effect of the Visual Presentation of a Craniofacial Syndrome on Speech Intelligibility in Noise. Cleft Palate Craniofac J 2019; 56:1038-1043. [PMID: 30669867 DOI: 10.1177/1055665618825403] [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: 11/16/2022] Open
Abstract
OBJECTIVE Research has argued that a speaker's facial appearance can result in an "intelligibility cost" for the listener. The study investigated whether such an intelligibility cost exists for a visible repaired cleft lip and nasal asymmetry. SETTING University department. PARTICIPANTS Eight typical speakers provided speech samples. Twenty-eight naive listeners participated in a speech in noise experiment. INTERVENTIONS Listeners transcribed sentences in noise that were paired with faces of individuals with repaired cleft lip and nasal asymmetry or typical faces. They also rated speaker intelligibility and answered a questionnaire about their previous knowledge about cleft lip and palate. MAIN OUTCOME MEASURES Percentage of words transcribed correctly and intelligibility ratings, compared by experimental condition (photo of typical face or face with repaired cleft lip and nasal asymmetry) and speaker gender. RESULTS There were no statistically significant differences between speech stimuli that were presented with faces with repaired cleft lip and nasal asymmetry or typical faces. The percentage of words transcribed correctly by the listeners was lower for female speakers (F = 12.7, df = 1; P < .01). Speech intelligibility of female speakers was rated more poorly (F = 10.5, df = 1; P < .01). CONCLUSIONS Presence of a repaired cleft lip and nasal asymmetry did not result in an intelligibility cost for naive listeners. Future research should investigate possible effects of facial motion or previous knowledge.
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Affiliation(s)
- Tim Bressmann
- 1 Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Tamara Eick
- 1 Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Pardo
- 2 Department of Psychology, Montclair State University, Montclair, NJ, USA
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Patient-reported Outcomes in Facial Reconstruction: Assessment of FACE-Q Scales and Predictors of Satisfaction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e2004. [PMID: 30656106 PMCID: PMC6326617 DOI: 10.1097/gox.0000000000002004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/14/2018] [Indexed: 01/01/2023]
Abstract
Background There is a paucity of patient-reported outcome measures for facial trauma reconstruction. To measure satisfaction and health-related quality of life (HRQOL), following repair of traumatic facial fractures, we used the FACE-Q, a set of patient-reported outcome instruments designed for aesthetic facial surgery. As a step toward validating the scales for facial trauma, we evaluated their reliability. Methods This is a prospective study of patients following primary repair of traumatic facial fractures at a level 1 trauma center from 2016 to 2018. Six FACE-Q scales with relevance to the facial trauma population were completed by patients at their 1-month postoperative visits. Predictors of satisfaction were examined using multiple linear regression models. Reliability of the scales in this population was evaluated using psychometric methods. Results One hundred eighty-five participants fulfilled inclusion criteria. Mean scores for the 6 scales ranged from 59 (SD = 15) for Recovery-Early Life Impact to 94 (SD = 13) for Satisfaction with Medical Team. Predictors of lower satisfaction and/or HRQOL include current tobacco smoking status, mandibulomaxillary fixation, and Le Fort pattern fractures. All scales were found to have good to excellent reliability (Cronbach's alpha = 0.824-0.969). Conclusions Following repair of facial fractures, patient-reported outcomes can be reliably measured using FACE-Q scales. On average, patients report poor health-related quality of life in the early postoperative period. Predictors of low satisfaction and/or poor HRQOL include current smoking habit, mandibulomaxillary fixation, and Le Fort fractures.
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Tevis SE, James TA, Kuerer HM, Pusic AL, Yao KA, Merlino J, Dietz J. Patient-Reported Outcomes for Breast Cancer. Ann Surg Oncol 2018; 25:2839-2845. [DOI: 10.1245/s10434-018-6616-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 12/27/2022]
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