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Health-Related Quality of Life Throughout the Breast Reconstruction Process: A Prospective Cohort of 200 Patients with Long-Term Follow-Up
Ricardo J. Bello, MD, MPH, Chris Devulapalli, MD, Rika Ohkuma, MD, Pablo Baltodano-Fallas, MD, Nelson Rodriguez-Unda, MD, Mohamad E. Sebai, MBBS, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.

PURPOSE:
With rising breast reconstruction rates, questions remain on the impact of shifting modalities of reconstruction on quality-of-life (QoL) and their interaction with concurrent treatments, particularly post-mastectomy radiotherapy (PMRT). This study aimed to track QoL in breast reconstruction patients according to reconstructive modality and PMRT.
METHODS:
We prospectively tracked patients undergoing breast reconstruction at our institution from 2010 to 2013 using the Breast-Q© survey preoperatively, after tissue expander placement, and 6 and 12 months after final reconstruction. We used Paired t-test, ANOVA, and multiple linear regression to estimate associations between QoL, reconstruction type and timing, and PMRT.
RESULTS:
Of the 200 patients followed, 75 (37.5%) underwent implant-based, 118 (59%) autologous, and 7 (3.5%) pure fat grafting reconstructions. Thirty-three (16.5%) reconstructions were immediate, 146 (73%) staged, and 21 (10.5%) delayed. Fifty-one patients (25.5%) received PMRT. Autologous reconstruction was associated with higher Satisfaction with Breasts (p=0.001) and trended toward higher Physical Well-being of Chest (p=0.073). Delayed reconstructions were associated with higher Satisfaction with Breasts (p=0.005), Psychosocial Well-being (p=0.033), and Sexual Well-being (p=0.014). After adjusting for confounding, PMRT was associated with lower Psychosocial Well-being (p=0.040) and Sexual Well-being (p=0.036). PMRT showed significant interaction with type of reconstruction, wherein autologous reconstruction mitigated the negative impact of PMRT on Satisfaction with Breasts (p=0.032) and Physical Well-being of Chest (p=0.034).
CONCLUSION:
Autologous and delayed reconstruction are associated with higher QoL. Importantly, autologous reconstruction performed after PMRT may mitigate its negative effects. These findings are important in an economic environment driving trends towards implant-based and immediate reconstruction.


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