TY - JOUR
T1 - Patient-Reported Outcomes of Aesthetics and Satisfaction in Immediate Breast Reconstruction after Nipple-Sparing Mastectomy with Implants and Fat Grafting
AU - Qureshi, Ali A.
AU - Odom, Elizabeth B.
AU - Parikh, Rajiv P.
AU - Myckatyn, Terence M.
AU - Tenenbaum, Marissa M.
N1 - Funding Information:
Dr Myckatyn receives research funding and consulting fees from Allergan, Acelity, and RTI. Dr Tenenbaum received research funding from Mentor and Allergan, and consulting feeds from Allergan. Dr Parikh is supported by a National Institutes of Health (NIH) Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant, T32CA190194 (PI: Colditz), by the Foundation for Barnes-Jewish Hospital, and by Siteman Cancer Center. The content presented in this manuscript is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. The other authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
Publisher Copyright:
© 2017 The American Society for Aesthetic Plastic Surgery, Inc.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background: Direct-to-implant (DTI) and tissue expander/implant (TE/I) reconstructions are the most common implant-based reconstructions after nipple-sparing mastectomy (NSM). However, there are little data beyond complication rates comparing these options. Fat grafting has emerged as an adjunct in NSM reconstructions to improve aesthetic results; however, its impact on patient perceptions of aesthetic outcomes remain unknown. To improve patient-centered care, aesthetic outcomes must be considered from the patients' perspective. Objectives: To evaluate patient-reported outcomes of aesthetic satisfaction and quality of life in patients undergoing immediate DTI vs TE/I reconstruction after NSM and to assess the role of fat grafting on these outcomes. Methods: This is a prospective cohort study comparing NSM patients undergoing DTI or TE/I reconstruction. Patient-reported outcomes were evaluated using the BREAST-Q. Continuous and categorical variables were analyzed using t test and Fisher's exact test, respectively. Results: Fifty-nine patients underwent 113 reconstructions with either DTI (n = 41) or TE/I (n = 18). Mean follow up was 12.1 months. DTI and TE/I patients had comparable satisfaction with outcome, though TE/I patients had significantly larger final implant sizes. TE/I who underwent fat grafting also had significantly higher satisfaction with outcome and psychosocial wellbeing. Conclusions: Patient-reported outcomes are comparable between DTI and TE/I reconstructions after NSM. In order for TE/I patients to achieve a similar level of satisfaction, they may require a larger final implant and additional operations compared to DTI patients. Additionally, fat grafting improves overall satisfaction. TE/I patients may have different aesthetic expectations than DTI patients, emphasizing patient-centered discussions are essential to optimizing outcomes after NSM.
AB - Background: Direct-to-implant (DTI) and tissue expander/implant (TE/I) reconstructions are the most common implant-based reconstructions after nipple-sparing mastectomy (NSM). However, there are little data beyond complication rates comparing these options. Fat grafting has emerged as an adjunct in NSM reconstructions to improve aesthetic results; however, its impact on patient perceptions of aesthetic outcomes remain unknown. To improve patient-centered care, aesthetic outcomes must be considered from the patients' perspective. Objectives: To evaluate patient-reported outcomes of aesthetic satisfaction and quality of life in patients undergoing immediate DTI vs TE/I reconstruction after NSM and to assess the role of fat grafting on these outcomes. Methods: This is a prospective cohort study comparing NSM patients undergoing DTI or TE/I reconstruction. Patient-reported outcomes were evaluated using the BREAST-Q. Continuous and categorical variables were analyzed using t test and Fisher's exact test, respectively. Results: Fifty-nine patients underwent 113 reconstructions with either DTI (n = 41) or TE/I (n = 18). Mean follow up was 12.1 months. DTI and TE/I patients had comparable satisfaction with outcome, though TE/I patients had significantly larger final implant sizes. TE/I who underwent fat grafting also had significantly higher satisfaction with outcome and psychosocial wellbeing. Conclusions: Patient-reported outcomes are comparable between DTI and TE/I reconstructions after NSM. In order for TE/I patients to achieve a similar level of satisfaction, they may require a larger final implant and additional operations compared to DTI patients. Additionally, fat grafting improves overall satisfaction. TE/I patients may have different aesthetic expectations than DTI patients, emphasizing patient-centered discussions are essential to optimizing outcomes after NSM.
UR - http://www.scopus.com/inward/record.url?scp=85030647801&partnerID=8YFLogxK
U2 - 10.1093/asj/sjx048
DO - 10.1093/asj/sjx048
M3 - Article
C2 - 28379284
AN - SCOPUS:85030647801
SN - 1090-820X
VL - 37
SP - 999
EP - 1008
JO - Aesthetic Surgery Journal
JF - Aesthetic Surgery Journal
IS - 9
ER -