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Assessing Long Term Alloplastic Breast Reconstruction Efficacy In A Longitudinal Cohort Of 9,232 Patients
Minji Kim, BS, Sameer Massand, MD, Joshua Barnett, MD, Uchechukwu Amakiri, BS, Lillian Boe, PhD, Robert J. Allen, Jr., MD, Carrie S. Stern, MD, Babak Mehrara, MD, Jonas A. Nelson, MD, MPH;
Memorial Sloan Kettering, New York City, NY, USA
Purpose: Implant-based breast reconstruction (IBR) is the most common approach for postmastectomy reconstruction. However, no study has examined which IBR patients are more likely to have higher patient reported outcomes (PROs) beyond 2-years postoperatively. This study aims to determine which variables are associated with PROs at 5-years postoperatively and to assess the proportion of patients undergoing revision procedures.
Methods: Patients who underwent direct-to-implant and two-staged IBR between 2010 and 2022 and completed the BREAST-Q were included. Primary outcomes were the four BREAST-Q scores at 5-years. The minimally clinically important difference was a score difference of 4. Secondary outcomes were revision procedures, including breast revision, fat grafting, and nipple reconstruction.
Results: 9,232 patients were included. Satisfaction with Breasts decreased over the years while the other domains remained stable (1-year: 64 [IQR: 53,75] vs 5-year: 61 [52,73]). 1,600 (17%) of patients had BREAST-Q scores available at 5-years. Hispanic ethnicity (=-6.66, 95%CI: -10.32,-3.00,p<0.001), current smoking status (=-5.97, 95%CI:-10.68,-1.26, p=0.014), adjuvant radiation (=-8.11, 95% CI: -10.84,-5.38, p<0.001), and unilateral reconstruction (=-4.72, 95% CI:-6.37,-3.07,p<0.001) had clinically negative impact on Satisfaction with Breasts at 5-years. Patients who were Hispanic, current/former smokers, and receipt of adjuvant radiation had significantly lower long-term Physical Well-being of the Chest, Psychosocial, and Sexual Well-beings. 2,030 (22%) underwent revision procedures, of which 1,105 patients (50%) underwent more than 1 revisions.
Conclusion: Satisfaction with Breasts may decrease 5-years after IBR. Patients of Hispanic ethnicity, current/former smoking status, and undergoing radiation should be counseled about decreased long-term PROs and that many patients undergo additional procedures.
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