Skin-sparing mastectomy and immediate breast reconstruction: patient satisfaction and clinical outcome

Background Skin-sparing mastectomy (SSM) followed by immediate reconstruction has been advocated as an effective treatment option for patients with early-stage breast carcinoma. It minimizes deformity and improves cosmesis through preservation of the natural skin envelope of the breast. The purpose of this study was to evaluate postoperative morbidity, patients' satisfaction, and oncological safety for SSM and immediate breast reconstruction (IBR) with a latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis in patients with operable breast cancer. Methods Twenty-one consecutive patients with operable breast cancer undergoing 25 SSM and immediate reconstruction with an LD flap plus implant (n = 14) or implant alone (n = 11) were retrospectively studied (from 2001 through 2005). The median patients' age was 44 years (range, 30–68). Patient satisfaction with the outcome of surgery was assessed using a detailed questionnaire including a linear visual analogue scale ranging from 0 (not satisfied) to 10 (most satisfied). Eight of 20 (40%) patients required adjuvant chemotherapy, and only 2 patients required post-mastectomy radiation. Reconstruction of the nipple–areola complex was performed in 7 patients (33%) using the trefoil local flap technique. Contralateral procedures to achieve symmetry were performed in 6 (28%) patients (5 augmentations and 1 reduction mammoplasty). Results Histological analysis showed pure ductal carcinoma in situ (DCIS) in 4 patients and invasive carcinoma (+/− DCIS) in 20 cases, of which 5 (25%) were node positive. One prophylactic mastectomy in a BRCA-2 carrier was negative for malignancy. Tumor size ranged from 5 to 90 mm. The surgical margins were clear in all cases. There was no delay in time to commencement of adjuvant therapies. After a mean follow-up period of 13.5 months (range, 5–46 months), none of the patients developed locoregional recurrence. Only 1 patient (5%) developed systemic recurrence (bony metastases). Overall survival was 100%. The incidence of flap necrosis/loss, implant loss, wound infection, or hematoma requiring surgical evacuation was 0%, 0%, 0%, and 0%, respectively. Capsule formation requiring capsulotomy was observed in 3 of 21 patients (14%). The median patient satisfaction score was 10 (range, 6–10). Conclusion SSM and IBR for operable breast cancer is associated with a high level of patient satisfaction and low morbidity. The procedure seems to be oncologically safe, even in patients with high-risk (T3 or node-positive) carcinoma. The latter needs to be confirmed with greater numbers of patients and longer follow-up.     

Life quality of patients who underwent breast reconstruction after prophylactic mastectomy: systematic review

Background

Prophylactic mastectomy is used to reduce the incidence of breast cancer in women with genetic predisposition and family history of breast cancer, and the rate of application is increased nowadays. Chronic pain, body image, and sexuality may negatively affect quality of life, while patients generally have increased quality of life and satisfaction after prophylactic mastectomy. The aim of this study is the evaluation of the results of the studies about quality of life of patients who underwent breast reconstruction after prophylactic mastectomy.

Methods

For the 1996–2016 literature, we searched the databases of Scopus, Science Direct, PubMed, EBSCO, Cochrane, Medline Complete, Ovid, Springer Link, Google Academic, Taylor & Francis, PsychINFO databases. For the gray literature, National Thesis Center and ULAKBIM databases were searched. Seven studies complying with the criteria were included in the review.

Results

Seven studies included in this study aimed to investigate the effect of prophylactic mastectomy on breast pain, numbness, sexuality and quality of life. When the studies were reviewed, we were found that the majority of the patients were satisfied with the results of the procedure, although the body image perception and pain/ movement/ perception and sexual problems were experienced after the breast surgery.

Conclusions

While overall satisfaction with cosmetic results was high, most women were not satisfied with the softness of the reconstructed breasts, and had problems with breast hardness, numbness and sex. Therefore, it is very important to inform the patients about the complications that may develop after the operation, while there is not enough data about the importance of informing the patients before the operation.

     

乳腺癌保留乳头乳晕切除即刻乳房重建术后患者生活质量的评价

目的:观察分析保留乳头乳晕乳腺切除术后即刻假体乳房重建术患者的美容效果和生活质量。方法:回顾性分析陕西省人民医院2015年5月至2016年9月收治并行保留乳头乳晕乳腺切除术后即刻假体乳房重建组（20例）与乳腺切除+前哨淋巴结活检术组（20例）的乳腺癌患者临床病理资料,术后就乳房重建的美容效果及随访1年生活质量等数据进行组间比较。结果:两组的平均年龄、TNM分期及文化程度等资料差异均无统计学意义（P＞0.05）;随访1年两组生活质量通过乳腺癌患者生命质量测定量表评价结果表明,重建组在社会/家庭状况、情感状况、功能状况、附加关注方面的得分均高于对照组,重建组显著优于对照组（P＜0.05）;而在生理状况评分方面无明显差异。结论:保留乳头乳晕乳腺切除术后即刻假体乳房重建术较乳腺切除+前哨淋巴结活检手术具有创伤小、效果良好、外形美观、生活质量高等优势,值得临床推广。     

Risk-reduction mastectomy: clinical issues and research needs

Risk-reduction mastectomy (RRM), also known as bilateral prophylactic mastectomy, is a controversial clinical option for women who are at increased risk of breast cancer. High-risk women, including women with a strong family history of breast cancer and BRCA1/2 mutation carriers, have several clinical options: risk-reduction surgery (bilateral mastectomy and bilateral oophorectomy), surveillance (mammography, clinical breast examination, and breast self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent data on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the perception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care providers in the decision-making process.     

Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes

BACKGROUND:

For this study, the authors evaluated early psychosocial adjustments and health‐related quality‐of‐life changes after breast reconstruction.

METHODS:

All consecutive patients who underwent breast reconstruction between June 2009 and November 2010 were asked to complete the BREAST‐Q, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale (IES) questionnaires before surgery and at 3 weeks and 3 months after surgery. A repeated‐measures design was used to compare scores between baseline and postoperative time points.

RESULTS:

Fifty‐one of 55 women completed the questionnaires (response rate, 93%). BREAST‐Q subscale scores (breast, sexual well being, and psychosocial well being) improved significantly (P < .05) postoperatively. The other subscale scores related to physical well being of the chest and abdomen dropped significantly 3 weeks after reconstruction; and, by 3 months after reconstruction, both scores improved significantly (P < .05). Large effect sizes for improvements in satisfaction, psychosocial well being, and sexual well being were observed (1.88, 1.2, and 1.31, respectively); whereas deterioration in the effect size for abdominal donor site was reported (?1.56). After adjusting for postoperative complications, there were statistically significant changes in BREAST‐Q subscale scores. Changes observed on the HADS and IES provided external validation of the findings obtained on the BREAST‐Q.

CONCLUSIONS:

The current results suggested that the gains in breast satisfaction, psychosocial well being, and sexual well being after patients undergo either free muscle‐sparing transverse rectus abdominis myocutaneous flap reconstruction or deep inferior epigastric artery flap reconstruction are statistically significant and clinically meaningful to the patient as early as 3 weeks after surgery. However, these gains are accompanied by significant deterioration in physical well being of the abdominal donor site. Cancer 2011;. © 2011 American Cancer Society.     

Skin sparing mastectomy and immediate breast reconstruction: A review

Aims

Skin Sparing Mastectomy (SSM) is widely practised now in major centres which manage large numbers of breast cancer but anxiety still exists over the safety of SSM both from oncological and aesthetic points of view. We aim to review literature to date in SSM and summarise and discuss the current evidence.

Methods

Studies were identified by an online search of the English language literature in the PubMed database till April 2012 followed by an extensive review of bibliographies from relevant articles.

Results

There is abundance of evidence with regards to the safety of SSM both oncologically and aesthetically especially in immediate breast reconstruction. The use of SSM technique broadens the repertoire of oncoplastic techniques and at the same time facilitates such techniques by preserving patient's native skin and anatomical landmarks.

Conclusions

SSM is a safe technique providing better cosmetic outcome without compromising oncological safety as per the current evidence. However, prospective data collection of its application in various newer types of reconstructions, and continuing long-term follow-up of current data series would be prudent to evaluate long-term outcomes.     

Local recurrence of stage 1 and 2 breast cancer after skin-sparing mastectomy and immediate breast reconstruction in a 15-year series

Aims

Since the introduction of skin-sparing mastectomy (SSM) in 1991 concerns on local control and recurrence rates have been discussed in the literature. The aim of this study is to examine in particular incidence of local recurrence in a 15-year consecutive series of breast cancer patients having undergone SSM and immediate breast reconstruction (IBR) at a single population-based institution.

Methods

One hundred and forty-six consecutive patients with either stage 1 or 2 breast cancer who underwent SSM followed by IBR from 1992 to 2006 were included in this study. A retrospective review of patient records was conducted.

Results

During a mean follow-up time of 51 months, four local recurrences of the native breast skin were accounted for. In addition, three regional lymph node recurrences and four systemic recurrences took place. All of the local and regional recurrences were handled by salvage surgery followed by adjuvant oncological therapies. During a mean follow-up of 35 months after the detection and treatment of the locoregional recurrences none of the patients developed new recurrences.

Conclusions

Our present study concludes that SSM followed by IBR seems oncologically sound procedure for stage 1 and 2 breast cancer patients. In addition, local recurrences and regional lymph node recurrences are not always associated with systemic relapse.     

Comparison of immediate breast reconstruction after mastectomy and mastectomy alone for breast cancer: A meta-analysis

Background

The purpose of this study was to compare patient outcomes between immediate breast reconstruction (IBR) after mastectomy and mastectomy alone.

The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review

In recent years, doubt has been shed on the necessity of mastectomy for women with early-stage breast cancer. Apart from purely medical studies comparing (radical) mastectomy to less intruding surgical treatment, a number of studies (N = 18) have been published investigating the impact of breast-conserving treatment versus mastectomy on quality of life. We review these studies with respect to medical issues (treatment modality, stage of disease), methodologic issues (design, measurement moment, sample size), and results (psychologic discomfort, changes in life patterns, fears and concerns). It is concluded that there is no solid proof of a better psychologic adjustment after breast-conserving treatment and that there are no substantial differences between the different treatment modalities in changes of life patterns and fears and concerns. However, the results with respect to body image and sexual functioning favor the use of breast-conserving treatment.     

Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study

Background  

The management of early breast cancer (BC) with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on level-1 evidence. In this study, the oncological outcome, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis is evaluated.     

Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer

The outcome of bilateral prophylactic mastectomy with breast reconstruction (BPM-IBR) in healthy BRCA1/2 mutation carriers can be potentially burdensome for body image and the intimate relationship. Therefore, in the current analysis the impact on body image, sexual and partner relationship satisfaction was prospectively investigated in women opting for BPM-IBR as well as cancer distress and general quality of life. Healthy women undergoing BPM-IBR completed questionnaires preoperatively (T0, n = 48), at 6 months (T1, n = 44) and after finishing breast reconstruction (median 21 months, range 12–35) (T2, n = 36). With multi-level regression analyses the course of outcome variables was investigated and a statistically significant change in body image and/or sexual and partner relationship satisfaction was predicted by baseline covariates. Body image significantly decreased at T1. At T2 sexual relationship satisfaction and body image tended to be lower compared to baseline. The overall partner relationship satisfaction did not significantly change. At T2, 37 % of the women reported that their breasts felt unpleasantly, 29 % was not satisfied with their breast appearance and 21 % felt embarrassed for their naked body. Most body image issues remained unchanged in 30 % of the women. A negative body image was predicted by high preoperative cancer distress. BPM-IBR was associated with adverse impact on body image in a substantial subgroup, but satisfaction with the overall sexual and partner relationship did not significantly change in time. The psychosocial impact of BPM-IBR in unaffected women should not be underestimated. Psychological support should ideally be integrated both before and after BPM-IBR.     

Psychologic effects and esthetic results of breast reconstruction after mastectomy

A survey was conducted on 84 patients who chose to have breast reconstruction after mastectomy. A self-rating questionnaire was sent to each patient by mail to collect as much information about the patient as possible: individual status, reasons for requesting breast reconstruction, acceptance and advantages of having the new breast, satisfaction with the overall esthetic results, amount of patient information regarding breast reconstruction, and the source of this information. Once the questionnaire was completely filled out, it was returned by mail to the persons conducting this study. Fourty-three patients (51% of sample) replied with a completed questionnaire. When all the data for this survey were collected, an interesting factor emerged: 33 patients (76.7% of those who replied) reported being substantially satisfied with the esthetic results of their operation. When asked about the reasons for requesting breast reconstruction, 16 patients asserted their request was based on the desire to prove to themselves that they had overcome the disease, and 16 to improve body image. When asked about the advantages of breast reconstruction, 17 patients believed the operation would help improve inner feelings about the loss of the breast. Thus breast reconstruction is indeed an element of prime importance to mastectomized women, especially for their physical and psychological rehabilitation.     

乳腺癌改良根治术与Ⅰ期重建术后生活质量的对比分析

  目的   比较改良根治手术和乳房Ⅰ期重建手术对中国女性乳腺癌患者生活质量和满意度的影响。   方法   入选2011年7月至2013年7月间在中国医学科学院肿瘤医院接受手术治疗的乳腺癌患者60例,其中改良根治术组30例,乳房Ⅰ期重建组30例,分别给予乳腺癌患者生命质量测定量表（FACT-B）和自制量表。   结果   两组间基本资料、乳腺癌病理及切口愈合情况差异均无统计学意义（P > 0.05）,具有良好的匹配性。与改良根治术组相比,乳房Ⅰ期重建组患者具有较好的外形满意度（33.2±8.8 vs. 41.1±10.8,P=0.003）。但两组间FACT-B评分和心理影响评分差异无统计学意义（P > 0.05）。   结论   乳房Ⅰ期重建组患者外形满意度明显优于改良根治组。