Analyzing Patient Preference for Nipple-Areola Complex Reconstruction Using Utility Outcome Studies
Ahmed Ibrahim, M.D.1, Hani Sinno, MD, MEng2, Ali Izadpanah, MD, MSc2, Joshua Vorstenbosch, PhD2, Tassos Dionisopoulos, MD2, Adam Tobias, MD1, Bernard Lee, MD, MBA1, Samuel Lin, MD1.
1Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA, 2McGill University, Montreal, QC, Canada.
Breast reconstruction is generally performed in multiple stages and may include revisions to address issues with shape and symmetry. As such, there is no clear indication as to when the reconstructive process is complete. Nipple areolar reconstruction (NAC) has been deemed a fundamental part of the reconstructive process as patients associate it with completeness of their management. We sought out to determine the impact of the health state burden of living with a reconstructed breast prior to NAC reconstruction.
A sample of the population and medical students at McGill University were recruited to establish the utility scores [visual analogue scale (VAS), Time-trade off (TTO), and standard gamble (SG)] of living with NAC deformity. Utility scores for monocular blindness (MB) and binocular blindness (BB) were determined for validation and comparison. Linear regression and student t-test were used for statistical analysis. A p<0.05 was deemed statistically significant.
103 prospective volunteers were included. Utility scores (VAS, TTO, SG) for NAC deformity were (0.84 ± 0.18, 0.92 ± 0.11, and 0.92 ± 0.11, respectively). Utility outcomes between the 2 groups, amongst ethnic groups, and amid males and females were not significantly different. Income thresholds of $10,000 revealed a statistically significance difference for VAS (p=0.049) and SG (p=0.015). Linear regression analysis showed that medical education was directly proportional to the SG and TTO scores (p <0.05) with increasing utility score of 0.048 and 0.014 in the SG and TTO for every increase in the level of medical education.
We have quantified the health burden of living with a NAC in a reconstructed breast using utility scores (VAS 0.84 ± 0.18, TTO 0.92 ± 0.11, SG of 0.92 ± 0.11)which can be compared to other breast related conditions. A numeric value has been assigned to this health state which can be used to form comparisons with the health burden of living with other medical conditions.
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