Plastic and Reconstructive Surgery, Global Open (Jun 2023)

Patient Perspectives and Quality of Life after Breast Reconstruction and the Impact of Subsequent Revisions

  • Lyndsay A. Kandi, BS,
  • Jacob B. Hammond, MD,
  • Haley Nadone, BS,
  • Heidi E. Kosiorek, MS,
  • Alanna M. Rebecca, MD, MBA,
  • William J. Casey, III, MD,
  • Edward M. Reece, MD, MBA,
  • Patricia A. Cronin, MD,
  • Barbara A. Pockaj, MD

DOI
https://doi.org/10.1097/GOX.0000000000004885
Journal volume & issue
Vol. 11, no. 6
p. e4885

Abstract

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Background:. There is limited research on the impact of revisional surgery after breast reconstruction on patient experience and postoperative quality of life (QoL). Methods:. Patients undergoing mastectomy with immediate implant-based or autologous free-flap breast reconstruction from 2008 to 2020 were reviewed. These patients were categorized by revisions (0–1, 2–3, and 4+) and surveyed on QoL metrics using BREAST-Q and Was It Worth It? (WIWI) questionnaires. BREAST-Q QoL, satisfaction, and WIWI metrics between revision groups were evaluated. Results:. Among 252 patients, a total of 150 patients (60%) underwent zero to one revisions, 72 patients (28%) underwent two to three revisions, and 30 patients (12%) underwent four or more revisions. Median follow-up was 6 years (range, 1–11 years). BREAST-Q satisfaction among patients with four or more revisions was significantly lower (P = 0.03), while core QoL domains (chest physical, psychosocial, and sexual well-being) did not significantly differ. Analysis of unplanned reoperations due to complications and breast satisfaction showed no significant difference in QoL scores between groups (P = 0.08). Regarding WIWI QoL metrics, four or more revisions were associated with a higher rate of worse QoL (P = 0.035) and worse overall experience (P = 0.001). Most patients in all revision groups felt it was worthwhile to undergo breast reconstruction (86%), would choose breast reconstruction again (83%), and would recommend breast reconstruction to others (79%). Conclusions:. Overall, a majority of patients undergoing revisions after breast reconstruction still have a worthwhile experience. Although reoperations after breast reconstruction do not significantly impact long-term BREAST-Q QoL domains, patients undergoing four or more revisions have significantly lower breast satisfaction, worse QoL, and a postoperative experience worse than expected.