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Aesthetic Outcome and Quality of Life after Breast Reconstruction: What positively influences patient’s satisfaction?

Eliana F R Duraes, MD1, Todd Baker, MD1, Megan Morisada, BA2, Susan Orra, BA2, Mona Ascha, BA2, Joao Batista de Sousa, MD, PhD3, Risal S. Djohan, MD1, Steven Bernard, MD1, Graham Schwarz, MD1, Andrea G. Moreira, MD1.
1Cleveland Clinic, Cleveland, OH, USA, 2Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA, 3University of Brasilia, Brasilia, Brazil.

PURPOSE: This study aims to establish factors influencing aesthetic
outcomes and patient reported quality of life(QOL) after breast reconstruction.
METHODS: From 2009-2011, patients who underwent any type of reconstruction received post-operative BreastQ3 questionnaires. Answers were compared according to patient and surgical related factors influencing
breast-related QOL. Post-operative photos from patients that answered the questionnaire were graded by a six-member blinded panel with a multi-parameter breast specific scale (scored 1-5).
RESULTS: 261 of 820 patients answered the questionnaires. Median length of follow-up was 48 (38-60) months. Satisfaction with breasts was higher in autologous reconstruction(ABR)(p<0.05), bilateral reconstructions (BiR)(p<0.01), and patients with body mass index(BMI)
25-29.9 versus >30 (p<0.05). Sexual well-being was higher in patients
with nipples either preserved or reconstructed (p<0.05). Radiation therapy(RT) was associated with lower satisfaction with outcome (p<0.05) and physical well-being (p<0.01). Psychosocial well-being was higher without RT (p<0.01), and BMI 25-29.9 versus >30 (p<0.01). 147 post-operative photos were evaluated. Superior aesthetic outcomes were observed for ABR vs implant-based reconstructions, no-RT vs RT, and BiR vs unilateral as shown in Table 1. There was a correlation between the aesthetic outcome and patient satisfaction with breasts (r=0.32, p<0.001).
CONCLUSION: Overall, patient satisfaction with breasts and aesthetic
outcomes are highest with ABR, BiR and without RT. Presence of lower BMI and nipple reconstruction positively influence satisfaction. An aesthetically pleasant breast does not guarantee patient satisfaction.


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