Invited Discussion on: The Impact of Reconstructive Modality and Postoperative Complications on Decision Regret and Patient-Reported Outcomes following Breast Reconstruction

Abstract Background While bipedicled free flaps enable increased soft tissue volume and potential for contralateral symmetry in unilateral breast reconstruction, the influence of bipedicled flap reconstruction on patient-reported outcomes remains unclear. Methods Patients undergoing unilateral free flap breast reconstruction at a single institution from 2014 to 2019 were retrospectively reviewed and sent the BREAST-Q and Decision Regret Scale. Complication rates and the BREAST-Q and Decisional Regret Scale scores (0–100) were compared between patients receiving bipedicled total abdominal and unipedicled hemiabdominal free flaps. Results Sixty-five patients undergoing unilateral breast reconstruction completed the BREAST-Q and Decision Regret Scale with median (interquartile range [IQR]) follow-up time of 32 [22–55] months. Compared with bipedicled flaps, patients receiving unipedicled hemiabdominal flaps had higher mean body mass index (BMI; p = 0.009) and higher incidence of fat grafting (p = 0.03) and contralateral reduction mammaplasties (p = 0.03). There was no difference in incidence of major or minor complications, abdominal hernias or bulges, or total operative time between bipedicled and unipedicled flaps (p > 0.05). Overall, BREAST-Q scores for satisfaction with breast, sexual wellbeing, psychosocial wellbeing, physical wellbeing (chest), and physical wellbeing (abdomen) and the Decision Regret Scale scores did not significantly vary between bipedicled and unipedicled reconstructions (all p > 0.05). However, among large-breasted patients (≥C cup), mean (standard deviation [SD]) sexual wellbeing was significantly higher after bipedicled total abdominal free flap reconstruction ([60.2 (23.3) vs. 46.2 (22.0)]; p = 0.04), though this difference did not reach significance after multivariate adjustment. Conclusion Unilateral breast reconstruction with bipedicled total abdominal free flaps results in similar complication risk, patient satisfaction, and decisional regret without the need for as many contralateral reduction procedures.

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Feasibility and acceptability of patient-reported outcomes data collection for clinical care following breast reconstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9042 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9042-9042 ◽

Cited By ~ 1

Author(s):

Andrea Pusic ◽

Anne Klassen ◽

Amie Scott ◽

Stefan Cano ◽

Marwan Shouery ◽

...

Keyword(s):

Data Collection ◽

Breast Reconstruction ◽

Patient Reported Outcomes ◽

Breast Surgery ◽

Clinical Care ◽

Well Being ◽

Privacy And Security ◽

Patient Reports ◽

Patient Reported ◽

The Impact

9042 Background: To date, systematic measurement of patient-reported outcomes (PROs) has played an important role in cancer research, but not in routine clinical care. Our objective was to evaluate the feasibility of developing and piloting an electronic PRO data collection in clinical care among breast reconstruction patients using the BREAST-Q, a previously developed condition-specific PRO measure for breast surgery patients that measures quality of life (e.g. psychosocial, physical and sexual well-being) as well as patient satisfaction (e.g. satisfaction with breasts, with information, with surgeon). Methods: The BREAST-Q was loaded to the MSKCC WebCore, a generic electronic patient-reporting platform adhering to strict privacy and security standards. Patients attending visits at the MSKCC Breast Reconstruction Clinic were asked to complete the BREAST-Q electronically prior to scheduled visits. For patients with email addresses, a reminder with web-link to the questionnaire was emailed automatically prior to the visit. Results: Over a 9 month start-up period, BREAST-Q surveys were completed by 1442 patients. Patients completed the questionnaire at set time points before and after surgery. A total of 2340 BREAST-Q surveys were completed overall. Mean completion time was 5:53 minutes. Acceptability was high with both patients and clinical staff contributing positive comments along with suggestions for improvement via email. Conclusions: This pilot experience suggests that ePRO data can be efficiently collected among outpatient breast surgery patients with high acceptability. In the next phase of this project, we will introduce real-time individual patient reports to the clinical team and evaluate the impact of this information on clinical care and quality improvement.

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Impact of Contralateral Symmetry Procedures on Long-Term Patient-Reported Outcomes following Unilateral Prosthetic Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1667365 ◽

2018 ◽

Vol 35 (02) ◽

pp. 124-128 ◽

Cited By ~ 1

Author(s):

Shantanu Razdan ◽

Hina Panchal ◽

Claudia Albornoz ◽

Andrea Pusic ◽

Colleen McCarthy ◽

...

Keyword(s):

Breast Reconstruction ◽

Patient Reported Outcomes ◽

Statistical Significance ◽

Multivariable Analysis ◽

Well Being ◽

Contralateral Breast ◽

Prosthetic Reconstruction ◽

Patient Reported ◽

The Impact

Background One aim of unilateral postmastectomy breast reconstruction (BR) is to restore symmetry with the contralateral breast. As such, unilateral prosthetic reconstruction often requires a contralateral symmetry procedure (CSP). There is sparse literature on the impact of CSPs on long-term patient-reported outcomes (PROs) such as satisfaction and health-related quality of life (HRQoL). This study aims to describe PROs following CSPs, using a validated PRO tool, BREAST-Q. The hypothesis is that CSPs are associated with greater patient-reported satisfaction and HRQoL. Methods This study is a single institutional analysis of prospectively collected BREAST-Q scores of patients who underwent unilateral prosthetic BR during 2011 to 2015. Women 18 years and older with BREAST-Q scores measured ≥ 9months after BR with or without CSP(s) at the time of expander replacement were included. Patients were classified into four subcohorts: augmentation, mastopexy, reduction, and no symmetry procedure (controls). Sociodemographic, clinical characteristics, and BREAST-Q scores were analyzed. Multivariable linear regression was performed. Results Of 553 patients, 67 (12%) underwent contralateral augmentation, 68 (12%) mastopexy, 93(17%) reduction, and 325 (59%) were controls. Mean follow-up time was 52 months. Satisfaction with breast and outcomes were higher in the augmentation compared with the control groups (p = 0.01). On multivariable analysis, augmentation remained an independent predictor of satisfaction with breast (p = 0.04). Physical well-being scores were lower for contralateral mastopexy and reduction compared with the controls with a trend toward statistical significance on multivariable models. Psychological and sexual well-being was similar across groups. Conclusion Prosthetic reconstruction with contralateral breast augmentation was associated with greater satisfaction with breast and reconstructive outcome. In contrast, breast reduction and mastopexy procedures demonstrated equivalent satisfaction with breasts compared with controls but may be associated with lower physical well-being. Such information can be used to improve the shared decision-making process for women who choose unilateral prosthetic BR.

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O58: THE IMPACT OF RADIOTHERAPY ON PATIENT-REPORTED OUTCOMES OF IMMEDIATE IMPLANT-BASED BREAST RECONSTRUCTION: RESULTS OF A PROSPECTIVE MULTICENTRE COHORT STUDY

British Journal of Surgery ◽

10.1093/bjs/znab117.058 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

E Sewart ◽

N Turner ◽

EJ Conroy ◽

R Cutress ◽

J Skillman ◽

...

Keyword(s):

Cohort Study ◽

Breast Reconstruction ◽

Patient Reported Outcomes ◽

Random Effect ◽

Well Being ◽

Patient Reported Outcome ◽

Complication Rates ◽

Informed Decisions ◽

Patient Reported ◽

The Impact

Abstract Introduction Post-mastectomy radiotherapy (PMRT) is increasing given to improve breast cancer outcomes but can increase complication rates following implant-based breast reconstruction (IBBR). Little, however, is known about the impact of PMRT on patient-reported outcomes (PROs) of IBBR, especially in the context of mesh-assisted techniques. Method 2108 consecutive women undergoing IBBR at 81 UK centres were prospectively recruited between 2014 and 2016. Demographic, operative, oncological and 3-month complication data were collected, and patients who consented received post-operative questionnaires. An 18-month questionnaire assessed PROs using the validated BREAST-Q. The effect of IBBR on PROs was investigated using mixed-effects regression models adjusted for clinically relevant confounders and including a random effect to account for potential clustering by centre. Result 1693 iBRA participants underwent mastectomy for malignancy, of whom 1187 (70%) consented to receive the 18-month questionnaire and 732 (43%) completed it. Patients undergoing PMRT (n=214) reported significantly worse scores across 3 BREAST-Q domains: satisfaction with breasts (-6.27 points, p=0.008, 95% confidence interval (CI)[-10.91,-1.63]), satisfaction with outcome (-7.53 points, p=0.002, CI[-12.20,-2.85]) and physical well-being (-6.55 points, p<0.001, CI[-9.43,-3.67]). Overall satisfaction was worse in the PMRT group (OR 0.497, p=0.002, CI[0.32,0.77]). Use of biological mesh did not ameliorate the impact of PMRT on patient satisfaction (interaction term p-values [0.173 - 0.826]). Conclusion: PMRT adversely affects PROs of IBBR. This should be discussed with patients considering IBBR, especially if PMRT is anticipated or indications are borderline, to enable informed decisions regarding oncological and reconstructive options. Abbrev PMRT: post-mastectomy radiotherapy, PRO: patient-reported outcome Take-home message This multicentre, prospective cohort study of 732 patients undergoing implant-based breast reconstruction demonstrates worse 18-month patient-reported outcomes in women who received post-mastectomy radiotherapy than those who did not. These data should be discussed with patients to help them make informed decisions about reconstructive surgery.

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The Impact of Obesity on Patient-Reported Outcomes Following Autologous Breast Reconstruction

Annals of Surgical Oncology ◽

10.1245/s10434-019-08073-5 ◽

2019 ◽

Vol 27 (6) ◽

pp. 1877-1888 ◽

Cited By ~ 1

Author(s):

Jonas A. Nelson ◽

Nikhil Sobti ◽

Aadit Patel ◽

Evan Matros ◽

Colleen M. McCarthy ◽

...

Keyword(s):

Breast Reconstruction ◽

Patient Reported Outcomes ◽

Autologous Breast Reconstruction ◽

Patient Reported ◽

The Impact

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Impact of Postoperative Complications on Fulfillment of Expectations after Orthopaedic Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00168 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0016

Author(s):

Bopha Chrea ◽

Jensen K. Henry ◽

Jonathan Day ◽

Andrew R. Roney ◽

Elizabeth Cody ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Management ◽

Postoperative Complications ◽

Patient Reported Outcomes ◽

Foot And Ankle ◽

Ankle Surgery ◽

Patient Reported ◽

Removal Of Hardware ◽

Preoperative Expectations ◽

The Impact

Category: Other Introduction/Purpose: Fulfillment of patients’ expectations following foot and ankle surgery has been previously studied and validated in assessing patient-reported outcomes (PROs). While this assessment has been shown to correlate well with patient satisfaction and PROs, the impact of postoperative complications on fulfillment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfillment of patients’ expectations. Methods: Preoperatively, patients completed a validated Foot and Ankle expectations survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. The FP ranges from 0 (no expectations fulfilled), between 0 and 1 (expectations partially fulfilled), 1 (expectations met), to greater than 1 (expectations surpassed). In addition, patient-reported outcomes (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (unplanned return to OR, reoperation, or revision). Results: Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication; 27 major (17 revisions, 10 removal of hardware due to pain/infection) and 6 minor (6 superficial infections requiring antibiotics). Complications were associated with significantly worse FP (0.69 +- 0.45 vs 0.86 +- 0.40, p=0.02). Average time from complication to completion of fulfillment survey was 15 (+-3.6) months. Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP (p<0.001). FAOS domains were similar preoperatively; postoperatively patients without complications had significantly higher ADL and QoL scores (p<0.05). Demographically, there was no difference in age, sex, BMI, Charlson Comorbidity Index, depression/anxiety, or pain management between the two groups. The groups were similar in diagnoses. Conclusion: Our data suggests that postoperative complications following foot and ankle surgery are associated with worse patient-reported fulfillment of their surgical expectations. This finding is independent of preoperative expectations, and correlates with several validated outcomes measures including patient satisfaction. Therefore, while patient fulfillment following foot and ankle surgery is multifactorial, the importance of preoperative education and counselling for potential complications should not be overlooked.

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Patient-reported outcomes of immediate implant-based breast reconstruction with and without biological or synthetic mesh

BJS Open ◽

10.1093/bjsopen/zraa063 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

E Sewart ◽

N L Turner ◽

E J Conroy ◽

R I Cutress ◽

J Skillman ◽

...

Keyword(s):

Breast Reconstruction ◽

Patient Reported Outcomes ◽

Random Effect ◽

Synthetic Mesh ◽

Supporting Evidence ◽

Two Stage ◽

Patient Reported ◽

Immediate Implant ◽

The Impact ◽

Dermal Sling

Abstract Background Biological and synthetic meshes may improve the outcomes of immediate implant-based breast reconstruction (IBBR) by facilitating single-stage procedures and improving cosmesis. Supporting evidence is, however, limited. The aim of this study was to explore the impact of biological and synthetic mesh on patient-reported outcomes (PROs) of IBBR 18 months after surgery. Methods Consecutive women undergoing immediate IBBR between February 2014 and June 2016 were recruited to the study. Demographic, operative, oncological and 3-month complication data were collected, and patients received validated BREAST-Q questionnaires at 18 months. The impact of different IBBR techniques on PROs were explored using mixed-effects regression models adjusted for clinically relevant confounders, and including a random effect to account for clustering by centre. Results A total of 1470 participants consented to receive the questionnaire and 891 completed it. Of these, 67 women underwent two-stage submuscular reconstructions. Some 764 patients had a submuscular reconstruction with biological mesh (495 women), synthetic mesh (95) or dermal sling (174). Fourteen patients had a prepectoral reconstruction. Compared with two-stage submuscular reconstructions, no significant differences in PROs were seen in biological or synthetic mesh-assisted or dermal sling procedures. However, patients undergoing prepectoral IBBR reported better satisfaction with breasts (adjusted mean difference +6.63, 95 per cent c.i. 1.65 to11.61; P = 0.009). PROs were similar to those in the National Mastectomy and Breast Reconstruction Audit 2008–2009 cohort, which included two-stage submuscular procedures only. Conclusion This study found no difference in PROs of subpectoral IBBR with or without biological or synthetic mesh, but provides early data to suggest improved satisfaction with breasts following prepectoral reconstruction. Robust evaluation is required before this approach can be adopted as standard practice.

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