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Outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study Part II: Patient-reported Outcomes
Andrea L. Pusic, M.D. M.H.S.1, Hyungin Myra Kim, Sc.D.2, Jennifer B. Hamill, M.P.H.3, Ji Qi, M.S.3, Edwin G. Wilkins, M.D., M.S.3.
1Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA, 3Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.

Purpose:  The goal of post-mastectomy reconstruction is to minimize deformity and optimize quality of life as perceived by the patient. This study prospectively evaluates patient-reported outcomes for breast reconstruction patients.
Methods:   Eleven sites enrolled women undergoing first time, immediate or delayed reconstruction following mastectomy.  Procedures included implant-based, latissimus dorsi, pedicle TRAM, free TRAM and DIEP reconstructions.  Patients completed the BREAST-Q and PROMIS-29 preoperatively and at one year post-surgery. For each outcome, separate linear mixed-effects models were used to test for within-patient one-year outcomes and to compare outcomes across procedure types. Both models were weighted for non-response and used site as random intercepts, and the latter was adjusted for baseline covariates. 
 
Results:  1552 MROC patients were included, and 1130 (73%) responded to one-year questionnaires.  Across procedure types, immediate reconstruction patients experienced satisfaction with their breasts and psychosocial well-being equal to or better than preoperative status. Physical well-being of the chest was not fully restored (p<0.001 implant patients; p=0.02 autologous), nor was physical well-being of the abdomen for autologous patients (p<0.001). Autologous patients reported greater satisfaction with their breasts compared to implant patients, adjusting for covariates (p<0.001).
Conclusion:  One year after surgery, patients experience satisfaction with their breasts equal to or greater than their preoperative status; physical well-being, however, is not fully restored.  Patients who choose autologous reconstruction are more satisfied with their breasts than implant patients. 


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