Comparison of patient-reported achievements of goals and core outcomes with delayed breast reconstruction in irradiated patients: latissimus dorsi with an implant versus DIEP

Jonas Löfstrand; Anna Paganini; Mattias Lidén; Emma Hansson

doi:10.2340/jphs.v58.12417

Authors

Jonas Löfstrand Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
Anna Paganini Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden; Department of Diagnostics, Acute and Critical Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg
Mattias Lidén Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
Emma Hansson Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden

DOI:

https://doi.org/10.2340/jphs.v58.12417

Keywords:

Latissimus dorsi flap, deep inferior epigastric perforator flap, breast reconstruction, patient-reported outcome, patient satisfaction, long-term follow-up

Abstract

Background: Different women’s individual goals with a breast reconstruction vary, and few studies compare techniques in light of the different goals. This study aimed to compare patient-reported core outcomes in patients reconstructed with deep inferior epigastric artery perforator (DIEP) flaps and latissimus dorsi (LD) flaps. Second, breast-related factors that the patients were particularly satisfied/dissatisfied with were analyzed.
Methods: This was a retrospective cross-sectional study, which includes women who had undergone
mastectomy and radiation, followed by delayed breast reconstructions with either LD flap and implant or DIEP flap during 2007–2017. The patient-reported core outcomes of overall breast-specific quality of life, normality, women’s cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being were analyzed using BREAST-Q.
Results: The patients were divided into LD and implant (n = 135 patients) and DIEP (n = 118 patients) groups, and both were demographically similar. The median follow-up was 8 years. The DIEP group scored significantly higher than the LD and implant group in five out of six domains. A high satisfaction was reported in questions regarding the feeling or appearance when having clothes on, whereas the greatest dissatisfaction was reported regarding questions entailing symmetry and the appearance without clothes.
Conclusion: After 7 years, patients’ breast-specific quality of life, normality, women’s cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being seem to be higher in irradiated patients who have been reconstructed with DIEP flap as compared to patients reconstructed with LD flap and implant. In both groups, patient satisfaction is high regarding their appearance when clothed, whereas the lowest satisfaction scores were reported in situations without clothing.

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References

Reaby LL. Reasons why women who have mastectomy decide to have or not to have breast reconstruction. Plast Reconstr Surg. 1998;101(7):1810–1818. https://doi.org/10.1097/00006534-199806000-00006 DOI: https://doi.org/10.1097/00006534-199806000-00006

Schmidt JL, Wetzel CM, Lange KW, Heine N, Ortmann O. Patients’ experience of breast reconstruction after mastectomy and its influence on postoperative satisfaction. Arch Gynecol Obstet. 2017;296(4):827–834. https://doi.org/10.1007/s00404-017-4495-5 DOI: https://doi.org/10.1007/s00404-017-4495-5

Henry M, Baas C, Mathelin C. Reconstruction mammaire apres cancer du sein : les motifs du refus [Why do women refuse reconstructive breast surgery after mastectomy?]. Gynecol Obstet Fertil. 2010;38(3):217–223. https://doi.org/10.1016/j.gyobfe.2009.10.003 DOI: https://doi.org/10.1016/j.gyobfe.2009.10.003

Zahedi S, Colvill K, Lopez M, Phillips LG. Implications of demographics and socioeconomic factors in breast cancer reconstruction. Ann Plast Surg. 2019;83(4):388–391. https://doi.org/10.1097/SAP.0000000000001919 DOI: https://doi.org/10.1097/SAP.0000000000001919

Elder EE, Brandberg Y, Bjorklund T, et al. Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast. 2005;14(3): 201–208. https://doi.org/10.1016/j.breast.2004.10.008 DOI: https://doi.org/10.1016/j.breast.2004.10.008

Flitcroft K, Brennan M, Costa D, Wong A, Snook K, Spillane A. An evaluation of factors affecting preference for immediate, delayed or no breast reconstruction in women with high-risk breast cancer. Psychooncology. 2016;25(12):1463–1469. https://doi.org/10.1002/pon.4087 DOI: https://doi.org/10.1002/pon.4087

Rowland JH, Holland JC, Chaglassian T, Kinne D. Psychological response to breast reconstruction. Expectations for and impact on postmastectomy functioning. Psychosomatics. 1993;34(3):241–250. https://doi.org/10.1016/S0033-3182(93)71886-1 DOI: https://doi.org/10.1016/S0033-3182(93)71886-1

Lindegren A, Halle M, Docherty Skogh AC, Edsander-Nord A. Postmastectomy breast reconstruction in the irradiated breast: a comparative study of DIEP and latissimus dorsi flap outcome. Plast Reconstr Surg. 2012;130(1):10–18. https://doi.org/10.1097/PRS.0b013e3182547aaf DOI: https://doi.org/10.1097/PRS.0b013e3182547aaf

Yueh JH, Slavin SA, Adesiyun T, et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg. 2010;125(6):1585–1595. https://doi.org/10.1097/PRS.0b013e3181cb6351 DOI: https://doi.org/10.1097/PRS.0b013e3181cb6351

Pluvy I, Bellidenty L, Ferry N, Benassarou M, Tropet Y, Pauchot J. Le lambeau perforant abdominal (DIEP) et grand dorsal autologue en reconstruction mammaire. Etude retrospective comparative a propos des 60 premieres patientes d’un meme operateur [Abdominal perforator flap (DIEP) and autologous latissimus dorsi in breast reconstruction. A retrospective comparative study about the first 60 cases of a same surgeon]. Ann Chir Plast Esthet. 2014;59(2):103–114. https://doi.org/10.1016/j.anplas.2013.10.004 DOI: https://doi.org/10.1016/j.anplas.2013.10.004

Thorarinsson A, Frojd V, Kolby L, Ljungdal J, Taft C, Mark H. Long-term health-related quality of life after breast reconstruction: Comparing 4 different methods of reconstruction. Plast Reconstr Surg Glob Open. 2017;5(6):e1316. https://doi.org/10.1097/GOX.0000000000001316 DOI: https://doi.org/10.1097/GOX.0000000000001316

Potter S, Holcombe C, Ward JA, Blazeby JM, Group BS. Development of a core outcome set for research and audit studies in reconstructive breast surgery. Br J Surg. 2015;102(11):1360–1371. https://doi.org/10.1002/bjs.9883 DOI: https://doi.org/10.1002/bjs.9883

Elander A, Lundberg J, Karlsson P, et al. Indikation för bröstrekonstruktion med kroppsegen vävnad med fri lambå. Report 2011:03. The guidelines were created by The Swedish Association of Local Authorities and Regions, The Swedish National Board of Health and Welfare, and The Swedish Society of medicine. Stockholm 2011. https://docplayer.se/3032093-Indikation-for-brostrekonstruktion-med-kroppsegen-vavnad-med-fri-lamba.html

Brorson F, Thorarinsson A, Kolby L, Elander A, Hansson E. Early complications in delayed breast reconstruction: a prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients. Eur J Surg Oncol. 2020;46(12):2208–2217. https://doi.org/10.1016/j.ejso.2020.07.010 DOI: https://doi.org/10.1016/j.ejso.2020.07.010

Klassen AF, Pusic AL, Scott A, Klok J, Cano SJ. Satisfaction and quality of life in women who undergo breast surgery: a qualitative study. BMC Womens Health. 2009;9:11. https://doi.org/10.1186/1472-6874-9-11 DOI: https://doi.org/10.1186/1472-6874-9-11

Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg. 2012;129(2):293–302. https://doi.org/10.1097/PRS.0b013e31823aec6b DOI: https://doi.org/10.1097/PRS.0b013e31823aec6b

Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345–353. https://doi.org/10.1097/PRS.0b013e3181aee807 DOI: https://doi.org/10.1097/PRS.0b013e3181aee807

Weick L, Brorson F, Jepsen C, Lidén M, Jensen EW, Hansson E. Giving meaning to patient reported outcomes in breast reconstruction after mastectomy – a systematic review of available scores and suggestions for further research. Breast. 2021;61: 91–97. https://doi.org/10.1016/j.breast.2021.11.008 DOI: https://doi.org/10.1016/j.breast.2021.11.008

Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR, Clinical significance consensus meeting G. Methods to explain the clinical significance of health status measures. Mayo Clin Proc. 2002;77(4):371–383. https://doi.org/10.4065/77.4.371 DOI: https://doi.org/10.4065/77.4.371

Crosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003;56(5):395–407. https://doi.org/10.1016/S0895-4356(03)00044-1 DOI: https://doi.org/10.1016/S0895-4356(03)00044-1

Voineskos SH, Klassen AF, Cano SJ, Pusic AL, Gibbons CJ. Giving meaning to differences in BREAST-Q scores: minimal important difference for breast reconstruction patients. Plast Reconstr Surg. 2020;145(1):11e–20e. https://doi.org/10.1097/PRS.0000000000006317 DOI: https://doi.org/10.1097/PRS.0000000000006317

Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg. 2017;139(5):1046e–1055e. https://doi.org/10.1097/PRS.0000000000003241 DOI: https://doi.org/10.1097/PRS.0000000000003241

Klifto KM, Aravind P, Major M, et al. Establishing institution-specific normative data for the BREAST-Q reconstruction module: a prospective study. Aesthet Surg J. 2020;40(6):NP348–NP355. https://doi.org/10.1093/asj/sjz296 DOI: https://doi.org/10.1093/asj/sjz296

Cano SJ, Klassen AF, Pusic AL. From BREAST-Q to Q-score: Using Rasch measurements to better capture breast surgery. Joint International IMEKO TC1+ TC7+ TC13 Symposium August 31st-September 2nd 2011; Jena, Germany; 2011.

Longo B, D’Orsi G, Vanni G, Gagliano E, Buonomo CO, Cervelli V. Secondary breast reconstruction in small to medium-sized irradiated breasts: could Fat-Augmented LD (FALD) flap be a reliable alternative? Plast Reconstr Surg. 2023. https://doi.org/10.1097/PRS.0000000000010480 DOI: https://doi.org/10.1097/PRS.0000000000010480

Phan R, Hunter-Smith DJ, Rozen WM. The use of patient reported outcome measures in assessing patient outcomes when comparing autologous to alloplastic breast reconstruction: a systematic review. Gland Surg. 2019;8(4):452–460. https://doi.org/10.21037/gs.2019.07.04 DOI: https://doi.org/10.21037/gs.2019.07.04

Eltahir Y, Krabbe-Timmerman IS, Sadok N, Werker PMN, de Bock GH. Outcome of quality of life for women undergoing autologous versus alloplastic breast reconstruction following mastectomy: a systematic review and meta-analysis. Plast Reconstr Surg. 2020;145(5):1109–1123. https://doi.org/10.1097/PRS.0000000000006720 DOI: https://doi.org/10.1097/PRS.0000000000006720

Mattiuzzi C, Lippi G. Current cancer epidemiology. J Epidemiol Glob Health. 2019;9(4):217–222. https://doi.org/10.2991/jegh.k.191008.001 DOI: https://doi.org/10.2991/jegh.k.191008.001

Sores A, Peto K. Measuring of subjective quality of life. Proc Econ Finan. 2015;32:809–816. https://doi.org/10.1016/S2212-5671(15)01466-5 DOI: https://doi.org/10.1016/S2212-5671(15)01466-5

Katz SJ, Lantz PM, Paredes Y, et al. Breast cancer treatment experiences of Latinas in Los Angeles County. Am J Public Health. 2005;95(12):2225–2230. https://doi.org/10.2105/AJPH.2004.057950 DOI: https://doi.org/10.2105/AJPH.2004.057950

Alderman AK, Hawley ST, Janz NK, et al. Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population- based study. J Clin Oncol. 2009;27(32):5325–5330. https://doi.org/10.1200/JCO.2009.22.2455 DOI: https://doi.org/10.1200/JCO.2009.22.2455

Mehta SK, Sheth AH, Olawoyin O, et al. Patients with psychiatric illness report worse patient-reported outcomes and receive lower rates of autologous breast reconstruction. Breast J. 2020;26(10):1931–1936. https://doi.org/10.1111/tbj.13936 DOI: https://doi.org/10.1111/tbj.13936

Erdmann-Sager J, Wilkins EG, Pusic AL, et al. Complications and patient-reported outcomes after abdominally based breast reconstruction: Results of the mastectomy reconstruction outcomes consortium study. Plast Reconstr Surg. 2018;141(2): 271–281. https://doi.org/10.1097/PRS.0000000000004016 DOI: https://doi.org/10.1097/PRS.0000000000004016

Ochoa O, Garza R, 3rd, Pisano S, Chrysopoulo M, Ledoux P, Arishita G, et al. Prospective longitudinal patient-reported satisfaction and health-related quality of life following DIEP flap breast reconstruction: Relationship with body mass index. Plast Reconstr Surg. 2019;143(6):1589–1600. https://doi.org/10.1097/PRS.0000000000005616 DOI: https://doi.org/10.1097/PRS.0000000000005616

Kamel GN, Mehta K, Nash D, et al. Patient-reported satisfaction and quality of life in obese patients: a comparison between microsurgical and prosthetic implant recipients. Plast Reconstr Surg. 2019;144(6):960e–966e. DOI: https://doi.org/10.1097/PRS.0000000000006201

Cereijo-Garea C, Pita-Fernandez S, Acea-Nebril B, Rey-Villar R, Garcia-Novoa A, Varela-Lamas C, et al. Predictive factors of satisfaction and quality of life after immediate breast reconstruction using the BREAST-Q((c)). J Clin Nurs. 2018;27(7–8):1464–1474. https://doi.org/10.1111/jocn.14291 DOI: https://doi.org/10.1111/jocn.14291

Fracon S, Renzi N, Manara M, Ramella V, Papa G, Arnez ZM. Patient satisfaction after breast reconstruction: implants vs. autologous tissues. Acta Chir Plast. 2017;59(3–4):120–128.

Mehta SK, Olawoyin O, Chouairi F, et al. Worse overall health status negatively impacts satisfaction with breast reconstruction. J Plast Reconstr Aesthet Surg. 2020;73(11):2056–2562. https://doi.org/10.1016/j.bjps.2020.08.093 DOI: https://doi.org/10.1016/j.bjps.2020.08.093

Beesley H, Ullmer H, Holcombe C, Salmon P. How patients evaluate breast reconstruction after mastectomy, and why their evaluation often differs from that of their clinicians. J Plast Reconstr Aesthet Surg. 2012;65(8):1064–1071. https://doi.org/10.1016/j.bjps.2012.03.005 DOI: https://doi.org/10.1016/j.bjps.2012.03.005

Karimi M, Brazier J. Health, health-related quality of lfie, and quality of life: what is the difference? Parmacoeconomics. 2016;34(7):645–649. https://doi.org/10.1007/s40273-016-0389-9 DOI: https://doi.org/10.1007/s40273-016-0389-9

Lee M, Damhorst ML. Women’s body image throughout the adult life span: a living history approach. J Women Aging. 2021;34(6):810–827. DOI: https://doi.org/10.1080/08952841.2021.2015197