Stability Of Long Term Outcomes In Implant-based Breast Reconstruction: An Evaluation Of 12-year Surgeon- And Patient-reported Outcomes In 3489 Non-radiated And Radiated Implants
Akhil K. Seth, MD1, Peter G. Cordeiro, MD2.
1NorthShore University HealthSystem, Evanston, IL, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: Outcomes following prosthetic breast reconstruction have been well-studied. However, the majority of studies are limited by short-term follow-up, and a lack of aesthetic and patient-reported outcomes. This study objectively examines long-term surgeon-reported (SRO) and patient-reported (PRO) outcomes following two-stage prosthetic breast reconstruction.
Consecutive patients undergoing two-stage prosthetic breast reconstruction from 1994-2016 by the senior author (P.G.C.), with at least one-year follow-up after implant exchange, were retrospectively reviewed. Long-term SROs, including aesthetic and capsular contracture scores, and PROs using the BREAST-Q, were recorded at each outpatient visit and analyzed over the 12-year follow-up period.
RESULTS: Retrospective review revealed 2,284 patients, or 3,489 breasts, that fit the inclusion criteria. Aesthetic scores and capsular contracture rates remained stable over the entire follow-up period. Subset analysis demonstrated that bilateral and non-radiated reconstructions consistently had the highest aesthetic scores, while unilateral radiated breasts had the lowest. Radiated breasts consistently had high rates of capsular contracture, although the extent of contracture improved over time in all patients. PRO BREAST-Q scores showed either stability or improvement over time in all patients. Radiated and non-radiated patients demonstrated comparable long-term satisfaction with outcomes despite significant differences in satisfaction with their breasts.
Our study, the largest of its kind, demonstrates that prosthetic breast reconstruction outcomes do not deteriorate over time. This stability is apparent in both long-term SRO and PRO data measured in the same patients. These results contradict the surgical dogma surrounding prosthetic breast reconstruction, and therefore should be given significant consideration when counseling patients.
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