Long-term Patient-reports Satisfaction after Breast Cancer ...



Patient Satisfaction with Breast Reconstruction during the Long-Term Survivorship Period

Emily S. Hu, MD; Andrea L. Pusic, MD; Jennifer F. Waljee, MD, MPH; Latoya Kuhn, MPH; Edwin G. Wilkins, MD; Amy K. Alderman, MD, MPH

INTRODUCTION: Understanding reconstructive outcomes in the breast cancer survivorship period has important implications for patient counseling and shared-medical decision-making. Unfortunately, long-term data on patient-reported satisfaction with breast reconstruction are limited. The previous Michigan Breast Reconstruction Outcomes Study (MBROS) on patient satisfaction at one year post-breast reconstruction showed that patients who underwent autogenous reconstruction were significantly more satisfied, as compared to the expander/implant population.1 However, recent follow-up of these same patients two years post-reconstruction revealed that the type of technique had no significant effect on general patient satisfaction.2 Expander/implant and autogenous tissue breast reconstructions have different aging processes, and the time when these processes stabilize is unclear. Few studies have adequately assessed long-term patient-reported satisfaction outcomes in the breast reconstruction population.3-10 Our goal was to evaluate long-term patient satisfaction with the processes of care, the decision-making process, and final physical appearance between implant and autogenous tissue techniques.

METHODS: A cross-sectional self-administered questionnaire was given to University of Michigan patients who were diagnosed with breast cancer between 1977 and 2006 and had had breast reconstruction (response rate 70%). The sample included post-mastectomy patients with expander/implant (E/I) (N=109) and free and pedicle transverse rectus abdominus flap (TRAM) reconstructions (N=109). Each group was stratified into three post-reconstructive time periods: short-term (≤5 years), intermediate (6-8 years), and long-term (>8 years). Validated satisfaction items were scored on a 5-point Likert scale ranging from very dissatisfied to very satisfied. Responses were dichotomized into “satisfied” versus “not satisfied” using the following criteria: scores of “very satisfied” or “satisfied” (a 4 or 5 on the 5-point Likert scale) for all questions were considered “satisfied;” all other scores were considered “not satisfied.” Chi-square was used for the analyses.

RESULTS: Mean follow-up time after reconstruction was 6.5 years (range 1-18 years). Procedure type had no effect on outcomes in the short-term. However, in the intermediate and long-term, the type of reconstructive procedure considerably impacted patient satisfaction. At 6 to 8 years post-reconstruction, TRAM patients, compared to E/I patients, were significantly more satisfied with the reconstructed breast appearance (p ................
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