Patient-Reported Outcomes With Immediate Implant-Based or Autologous Breast Reconstruction
As reported in the Journal of Clinical Oncology by Pusic et al, patient-reported outcomes in the Mastectomy Reconstruction Outcomes Consortium Study indicate that autologous tissue breast reconstruction is associated with greater breast satisfaction and greater sexual and psychosocial well-being compared with implant-based reconstruction at 1 year after mastectomy for breast cancer.
Study Details
The study involved 1,632 women at 11 sites (57 plastic surgeons) in the United States and Canada who were undergoing immediate postmastectomy implant-based (n = 1,139) or autologous tissue (n = 493) reconstruction for invasive cancer or carcinoma in situ. Patients were asked to complete the condition-specific BREAST-Q patient-reported outcomes measure for breast surgery patients and the generic Patient-Reported Outcomes Measurement Information System–29 instrument before and 1 year after surgery (transformed scores ranged from 0–100, with higher scores indicating better outcome).
Improved Outcomes
Of the 1,632 patients, 72.5% responded at 1 year. In an analysis controlling for baseline values, outcomes at 1 year in BREAST-Q domains indicated that patients who underwent autologous vs implant-based reconstruction had greater satisfaction with their breasts (mean difference = 6.3, P < .001), greater sexual well-being (difference = 4.5, P = .003), and greater psychosocial well-being (difference = 3.7, P = .02).
Compared with baseline values, patients in the autologous group, but not those in the implant group (mean differences of 0.6 and 0.6), had improved satisfaction with their breasts (difference = 8.0, P = .002) and psychosocial well-being (difference = 4.6, P = .047). Sexual well-being was restored among patients who underwent autologous (difference = 1.2) but not implant reconstruction (difference = –5.2, P = .005). Physical well-being of the chest was not fully restored in either the implant group (–3.8, P = .001) or the autologous group (–2.2, P = .038), and physical well-being of the abdomen was not restored in the autologous group (–13.4, P < .001).
Anxiety and depression scores were improved in both groups at 1 year. Patients in the autologous group reported increased levels of pain interference (P = .006), and patients in the implant group reported decreased fatigue (P = .035).
The investigators concluded: “At 1 year after mastectomy, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial and sexual well-being than those who underwent implant reconstruction. Although satisfaction with breasts was equal to or greater than baseline levels, physical well-being was not fully restored. This information can help patients better understand expected outcomes and may guide innovations to improve outcomes.”
The study was supported by National Cancer Institute grants.
Andrea L. Pusic, MD, of Memorial Sloan Kettering Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.
The BREAST-Q is owned by Memorial Sloan Kettering Cancer Center and the University of British Columbia. Dr Pusic is a co-developer of BREAST-Q and receives royalties when it is used in for-profit industry-sponsored clinical trials.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
