Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study

doi:10.1016/j.breast.2004.10.008

The Breast

Volume 14, Issue 3, June 2005, Pages 201-208

https://doi.org/10.1016/j.breast.2004.10.008 Get rights and content

Summary

The aim of immediate breast reconstruction is to improve well-being and quality of life for women undergoing mastectomy for breast cancer. This prospective study used the SF-36 Health Survey questionnaire to assess quality of life before and 12 months after mastectomy and immediate breast reconstruction together with patients’ expectations of and satisfaction with the immediate breast reconstruction with implant. Scores for 76 participants were compared with those in 920 age-matched women from the general population. Preoperative scores for emotional well-being and physical role functioning were lower than in the reference population, while after 12 months the scores in all domains had improved and were comparable with those in the reference population. The most common reason for immediate reconstruction was the desire to avoid an external prosthesis. Most women were satisfied with immediate reconstruction, and the major determinant of aesthetic satisfaction was completion of the procedure. Although many factors may influence quality of life, 1 year after breast cancer surgery with immediate reconstruction scores are equivalent to those of the normal population.

Introduction

Breast cancer is the most common cancer in Swedish women.¹ Despite advances in conservative surgery, mastectomy with or without axillary clearance is the recommended surgical treatment option in many situations. These include multifocal tumours or ductal cancer in situ (DCIS) lesions and large or locally advanced tumours. As reported in several studies, the loss of a breast is a psychologically traumatic event for many women.2, 3 An increasing number of women wish for reconstruction of the lost breast, and methods for immediate and delayed breast reconstructions have been developed. Since the goal of reconstruction is to improve well-being in mastectomised women, it is important to evaluate what impact such reconstructive surgery has on quality of life. It is also important to assess patient satisfaction as a measurement of quality of care and to understand what expectations women have of the procedure. Most studies that have addressed these issues have used a retrospective and cross-sectional design.⁴ There is a lack of prospective studies evaluating psychosocial issues relating to immediate breast reconstruction. The aims of this study were to examine the reasons women gave for undergoing immediate breast reconstruction, to determine general and aesthetic satisfaction with the results of reconstruction 1 year after surgery, and to assess the impact on quality of life using a validated measure of health outcomes. Responses were compared with those in an age-matched reference population.

Section snippets

Study population

The study population was made up of 76 consecutive patients diagnosed with breast cancer who underwent mastectomy followed by immediate breast reconstruction between August 1998 and July 2001 at the Karolinska Hospital. An expander/implant prosthesis was used in all cases. All patients were assessed by a multidisciplinary team, as described elsewhere.⁵

The median age of these patients was 46 years (range 25–71). The indication for surgery was cancer in situ in 17 women and invasive breast cancer

Health-related quality of life

The mean preoperative and 1-year postoperative SF-36 scores are shown in Table 2. Figure 1 illustrates the patients’ SF-36 health profiles compared with those in the age-matched reference population before and 1 year after surgery. The patients’ preoperative scores for the four scales primarily measuring emotional well-being and for physical role functioning (RP) were all significantly lower than those of the reference population. One year postoperatively there was a significant improvement in

Discussion

In this study 76 women were asked preoperatively and 1 year postoperatively to complete a questionnaire assessing their quality of life, expectations of reconstruction and outcome satisfaction. At the time of the first questionnaire, the SF-36 scores for physical and emotional role functioning, social functioning, vitality and mental health were all significantly lower than those for the normal population. This was expected, since these women were recently diagnosed with breast cancer and about

Acknowledgements

We thank all patients who completed questionnaires. We also thank Associate Professor Edwin G. Wilkins at the University of Michigan Hospitals for his help and for permission to translate parts of the MBROS questionnaire, Dr. Bo Nilsson for statistical review and Dr. Grahame Elder for valuable comments.

References (33)

J.H. Rowland et al.
Psychological response to breast reconstruction. Expectations for and impact on postmastectomy functioning
Psychosomatics
(1993)
M. Sullivan et al.
The Swedish SF-36 Health Survey. I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden
Soc Sci Med
(1995)
S.K. Al-Ghazal et al.
Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction
Eur J Cancer
(2000)
S.K. Al-Ghazal et al.
The psychological impact of immediate rather than delayed breast reconstruction
Eur J Surg Oncol
(2000)
M. Charavel et al.
Psychosocial profile of women seeking breast reconstruction
Eur J Obstet Gynecol Reprod Biol
(1997)
C.M. Contant et al.
Motivations, satisfaction, and information of immediate breast reconstruction following mastectomy
Patient Educ Couns
(2000)
E.A. Krueger et al.
Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy
Int J Radiat Oncol Biol Phys
(2001)
Cancer incidence in Sweden 2001
(2003)
W.S. Schain et al.
Mastectomy versus conservative surgery and radiation therapy. Psychosocial consequences
Cancer
(1994)
D. Harcourt et al.
Psychological aspects of breast reconstructiona review of the literature
J Adv Nurs
(2001)

M. Wickman et al.

Technical aspects of immediate breast reconstruction—two year follow-up of 100 patients treated consecutively

Scand J Plast Reconstr Surg Hand Surg

(1998)

M. Sullivan et al.

SF-36 Hälsoenkät. Swedish manual and interpretation guide

(1994)

J.E. Ware et al.

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection

Med Care

(1992)

A.K. Alderman et al.

Determinants of patient satisfaction in postmastectomy breast reconstruction

Plast Reconstr Surg

(2000)

S.G. Anderson et al.

Treatment considerations in postmastectomy reconstructiontheir relative importance and relationship to patient satisfaction

Ann Plast Surg

(1994)

M.J. Nissen et al.

Quality of life after breast carcinoma surgerya comparison of three surgical procedures

Cancer

(2001)

Cited by (312)

Immediate versus delayed breast reconstruction: Long-term follow-up on health-related quality of life and satisfaction with breasts
2024, Journal of Plastic, Reconstructive and Aesthetic Surgery
Health-related quality of life (HRQL) can be improved by breast reconstruction following mastectomy. The optimal timing of the reconstruction remains unclear.
A cross-sectional study on 338 women who had undergone immediate or delayed breast reconstruction between 08/2017 and 07/2019 was performed. The postoperative HRQL was assessed using the BREAST-Q Reconstruction Module and the 36-Item Short Form Survey (SF-36). Regression analysis was performed for group-wise comparison.
A total of 146 (43%) patients participated. Seventy-seven patients (53%) had undergone immediate, and 69 patients (47%) had delayed reconstruction. The median age was 55 years (interquartile ratio [IQR] 50–62) for the Immeda group te, and 60 years (IQR 54–65) for the delayed reconstruction group. The median follow-up time was 2.3 years (IQR 1.8–2.9). No difference between the groups was detected in satisfaction with breasts (median 61, IQR 53–71 vs. 62, IQR 46–71, p = 0.62), physical well-being of the chest (median 100, IQR 80–100 vs. 100, IQR 80–100, p = 0.95) or psychosocial well-being (median 69, IQR 54–83 vs. 62, IQR 54–74, p = 0.19). No difference was detected in the SF-36 domains either.
The timing of the breast reconstruction does not affect the postoperative HRQL. Patients with both immediate and delayed breast reconstruction reported high satisfaction with the breast and psychosocial well-being.
Oncological status is not a determinant of refraining from breast reconstruction among 490 candidates for mastectomy and post-mastectomy radiotherapy
2023, Journal of Plastic, Reconstructive and Aesthetic Surgery
Although breast reconstruction in the setting of post-mastectomy radiotherapy (PMRT) is controversial, we offer nipple-sparing mastectomy and immediate implant-based breast reconstruction ([N]SSM/IIBR) to women needing primary mastectomy regardless of PMRT. Nevertheless, some of these women have no reconstruction.
To assess the uptake of breast reconstruction in women who undergo PMRT and the patient characteristics associated with such uptake. Additionally, we assessed the determinants of forgoing breast reconstruction.
Demographic, physical and oncological characteristics of women who underwent mastectomy, PMRT and breast reconstruction were compared to the characteristics of those who did not undergo breast reconstruction from 2013 through 2018. As determinants of delaying or refraining from breast reconstruction, we distinguished between an oncological reason, patient’s preference, patient’s co-morbidity, combined tobacco abuse and obesity and the need for PMRT.
490 women received PMRT. Of these, 396 women (81%) underwent combined [N]SSM/IIBR and PMRT or mastectomy and PMRT with delayed breast reconstruction. Ninety-four additional women (19%) did not undergo breast reconstruction. The latter group differed significantly from those who did in demographic and physical characteristics but not in terms of oncological diagnosis and history. Patient’s preference was the single most frequent determinant of not performing either immediate or delayed breast reconstruction among these 94 women. Oncological status was not a major determinant in refraining from reconstruction.
The significant difference in non-oncological characteristics between the reconstructed and non-reconstructed women confirms the importance of these characteristics in the preference for either reconstruction or non-reconstruction.
Frailty among patients undergoing breast reconstruction surgery: A systematic review and meta-analysis
2023, Journal of Plastic, Reconstructive and Aesthetic Surgery
We conducted a systematic review and meta-analysis to evaluate the predictive value of frailty for predicting postsurgical complications in patients undergoing breast reconstruction surgery.
MEDLINE (PubMed), Scopus, Web of Science, and Embase were searched for relevant studies up to September 13, 2022. A systematic review and meta-analysis of studies were performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement criteria.
Nine studies were included in this research. The rates of overall complications (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.17–1.97, I2 = 76%; p = 0.002), wound complications (OR 1.87, 95% CI 1.56–2.26, I2 = 16%; p < 0.0001), readmissions (OR 1.94, 95% CI 1.61–2.34, I2 = 15%; p < 0.0001), and reoperations (OR 1.41, 95% CI 1.12–1.77, I2 = 39%; p = 0.003) were significantly greater in frail patients than in nonfrail undergoing breast reconstruction surgery. Furthermore, compared with nonfrail patients, this difference remained significantly higher among prefrail individuals (overall complications: OR 1.27, 95% CI 1.13–1.41, I2 = 67%; p < 0.001, wound complications: OR 1.48, 95% CI 1.33–1.66, I2 = 24%; p < 0.0001, readmission: OR 1.47, 95% CI 1.34–1.61, I2 = 0%; p < 0.0001, reoperation: OR 1.32, 95% CI 1.23–1.42, I2 = 0%; p < 0.0001). We found that frail patients undergoing immediate autologous reconstruction surgery are the most vulnerable to experiencing overall postoperative complications.
Frailty is a strong predictor of postsurgical complications after breast reconstruction surgery in frail and prefrail patients. The most frailty index utilized was the modified five-item frailty index (mFI-5). More research is needed on this topic to assess the utility of frailty in practice, especially in countries other than the United States.
Comparative evaluation using PRO of an algorithm of one-stage immediate alloplastic breast reconstruction versus two-stage reconstruction
2023, Journal of Plastic, Reconstructive and Aesthetic Surgery
One-stage direct-to-implant (DTI) immediate breast reconstruction has proven to be an oncologically safe technique, but there are some conditions that do not allow its performance. The introduction of new surgical techniques and the recent COVID-19 pandemic have pushed us to introduce a breast reconstruction algorithm in our clinical practice. This allows a one-stage immediate reconstruction for all patients, regardless of their anatomical characteristics, the type of implants used, and the need for postoperative radiotherapy.
A total of 40 patients were recruited and divided into two cohorts, 20 patients underwent immediate one-stage breast reconstruction in the period between October 2019 and January 2021, and 20 patients completed the two-stage reconstructive process in the period prior to October 2019. During the follow-up at 6 months, all patients who had completed the reconstructive process filled out the Breast-Q Reconstruction Module Pre and Postoperative scales questionnaire. The outcomes of the questionnaires were compared between the two cohorts, and statistical analysis was carried out using SPSS Statistics 20 (IBM Corporation, Armonk, NY, USA).
The analysis of patient-reported outcomes showed that patients from the one-stage group reported better outcomes in all items evaluated. We did not find statistically significant differences concerning the rate of complications and length of hospital stay between the two groups.
The analysis of the results shows that the outcomes reported by patients who completed breast reconstruction according to our algorithm are statistically better than those with the two-stage technique.
Reprint of: Satisfaction with life and perception of healthcare services
2023, International Journal of Hospitality Management
Healthcare institutions regularly evaluate consumers’ service experience as a measure of quality. This study considers patients’ well-being as an antecedent of service evaluations. In this cross-sectional study, 336 participants rated their satisfaction with life (SWL) and perceptions about the health institution regarding results, procedures, and interactions with personnel. Three independent regression models were developed, one for each dimension that predicted satisfaction with healthcare. Findings show that the participants’ SWL is related to their health service evaluation. An increase in SWL results in better evaluations regarding results (β = 0.15 **), procedures (β = 0.16 **), and interactions with personnel (β = 0.20 **). Moreover, on the three dimensions, the service evaluation differs by area; those attending outpatient consultations have better evaluations than those in the emergency department. This study confirms the importance of differentiating patient satisfaction by area and suggests controlling patients’ SWL as a subjective component that influences healthcare evaluations.
Factors Associated With Socioeconomic Disparities in Breast Reconstruction: Perspectives of Wisconsin Surgeons
2023, Clinical Breast Cancer
The objective is to expand our understanding of the factors associated with receipt of breast reconstruction for socioeconomically disadvantaged women within Wisconsin.
A purposeful sample of general/breast and plastic surgeons were identified. One-on-one interviews were conducted, audio-recorded, and transcribed in full (n = 15). Conventional content analysis was performed to identify themes.
Both general/breast and plastic surgeons perceived that general/breast surgeons served as gatekeepers to which patients are offered a referral for reconstruction. Given the additional recovery time, frequent clinic visits, and potential for complications associated with reconstruction, general/breast surgeons perceived that not all women prioritize it. Surgeons perceived this to be especially true for socioeconomically disadvantaged women. Surgeons identified time off work, travel for visits, and out-of-pocket costs as specific challenges to reconstruction experienced by socioeconomically disadvantaged women. Surgeons perceived that early education, incorporating financial considerations into discussions, and reducing travel burden may help to improve access to reconstruction.
Wisconsin surgeons described factors they perceived contributed to lower rates of reconstruction for socioeconomically disadvantaged women and described ways to increase reconstruction access.

View all citing articles on Scopus

^☆: This study was supported by grants from the King Gustaf V Jubilee Fund, the Swedish Cancer Society Stockholm (00138, 00182) and Fredrik and Ingrid Thuring Foundation.

View full text

ORIGINAL ARTICLEQuality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study☆

Summary

Introduction

Section snippets

Study population

Health-related quality of life

Discussion

Acknowledgements

Psychosomatics

Soc Sci Med

Eur J Cancer

Eur J Surg Oncol

Eur J Obstet Gynecol Reprod Biol

Patient Educ Couns

Int J Radiat Oncol Biol Phys

Cancer incidence in Sweden 2001

Mastectomy versus conservative surgery and radiation therapy. Psychosocial consequences

Cancer

Psychological aspects of breast reconstructiona review of the literature

J Adv Nurs

Technical aspects of immediate breast reconstruction—two year follow-up of 100 patients treated consecutively

Scand J Plast Reconstr Surg Hand Surg

SF-36 Hälsoenkät. Swedish manual and interpretation guide

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection

Med Care

Determinants of patient satisfaction in postmastectomy breast reconstruction

Plast Reconstr Surg

Treatment considerations in postmastectomy reconstructiontheir relative importance and relationship to patient satisfaction

Ann Plast Surg

Quality of life after breast carcinoma surgerya comparison of three surgical procedures

Cancer

ORIGINAL ARTICLE
Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study☆