"The really exciting thing about this particular study is the idea that we can show the impact of breast reconstruction on improving quality of life in women with breast cancer," says study co-researcher Andrea Pusic, MD, a plastic and reconstruction surgeon at Memorial Sloan-Kettering Cancer Center in New York. “Surprisingly, there’s been very little evidence showing breast reconstruction actually does make a difference in a woman’s life.”
Pusic and colleagues studied 51 women who had the procedure at the University of Toronto. Their ages ranged from 28 to 77. The women were asked to complete three questionnaires before reconstructive surgery and at three weeks and three months afterward. The researchers say it's the first study to look at patient satisfaction before and after breast reconstruction.
Asking the Questions
One of the questionnaires was called the BREAST-Q. Pusic, with the support of The Plastic Surgery Foundation, developed it to assess patient satisfaction and quality of life after breast reconstruction. The other questionnaires measured symptoms of anxiety, depression, and feelings and thoughts about cancer. Women weren’t too anxious or depressed before surgery, the researchers write, possibly because about two-thirds of those who’d delayed reconstruction no longer had active breast cancer.
There were improvements in satisfaction, psychosocial well-being, and sexual well-being as early as three weeks after reconstructive surgery, the study found.
However, the women did report deterioration in physical well-being for the abdomen, where tissue used to reconstruct their breasts had been removed. The reports of dissatisfaction included problems with abdominal discomfort, bloating, bulging, and muscle weakness.
The researchers say they expected to see a decrease in the abdominal physical well-being score but were surprised at how dissatisfied women still were three months after surgery. Longer-term follow-up is needed to see whether this score improves, the researchers say.
Before surgery, patients who’d delayed reconstruction expressed more dissatisfaction with their breasts than those who’d scheduled it for immediately after their mastectomy. But they quickly caught up after the operation.
Abdominal Tissue vs. Implants
Previous research found that women at first reported feeling worse mentally after breast reconstruction, according to Pusic and her co-researchers. One difference, they write, might be that those studies included women who’d had reconstruction with implants as well as those who decided to use their own tissue. A Harvard study published in 2010 of 439 women who’d had all types of breast reconstruction, including silicone gel and saline implants, found that those who’d used their own abdominal tissue were the most satisfied.
In the U.S., Pusic says, about 20% of reconstruction procedures are performed using the patient’s own abdominal tissue instead of implants. "Using your own tissue tends to be a bigger operation with a bigger recovery," she says, although the trade-off is that those who opt for implants are likelier to require more surgeries down the road.
Women haven’t had much to go on when trying to decide which reconstruction method is best for them, Pusic says. To help fill that gap, all reconstruction patients at Sloan-Kettering complete the BREAST-Q -- available in 12 languages -- before and after surgery.
"I’m trying to get information that women can use and we can communicate to patients," Pusic says.
Pusic and her colleagues published their findings online in Cancer.