Background:
Recent increasing awareness of health-related quality of life has led to higher patient expectation about post-mastectomy breast reconstruction. Besides, rising incidence of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) made patients choose the autologous breast reconstruction more than implant. The aim of this study is to analyze the aesthetic outcomes of autologous breast reconstruction and define possible factors affecting the results.
Patient and Methods:
The patients who underwent immediate or delayed autologous tissue reconstruction after mastectomy were recruited from October 2015 to June 2021, at a single institute in Taiwan. Patient demographic data, post-operative complications and secondary procedures for cosmetic reasons were identified retrospectively through medical chart review. Patient-reported outcomes (PROs) and perioperative image records were analyzed by using BREAST-Q questionnaire and BCCT.core respectively for aesthetic outcome evaluation.
Results:
Eighty-three women were enrolled and BREAST-Q questionnaire response rate was 73%. Mean follow up time was 36 (6-78) months. The mean BREAST-Q score for satisfaction with breasts was 60.46 (standard deviation (SD) = 19.09). The grading of post-operative BCCT.core evaluation had no statistical significance compared to pre-operative evaluation (P=0.245), and the most of patients (70.59%) had either the same (50%) or better results (20.59%) after reconstruction in BCCT.core evaluation. Postmastectomy radiotherapy (PMRT) had negative impact on psychosocial well-being (P=0.012), sexual well-being (P=0.002), and satisfaction with breast (P=0.026). However, three-dimensional breast mold might slightly improve BREAST-Q score in psychosocial well-being, sexual well-being, and satisfaction with breasts without statistical significance.
Conclusion:
Breast reconstruction with autologous tissue had acceptable complication rate and favorable aesthetic outcomes in both PROs and BCCT.core. PMRT led to significant worse results in PROs and three-dimensional breast mold may facilitate better outcomes. At last, objective evaluation with BCCT.core tended to overrate outcomes compared to PROs in our study.