Comparison of long-term outcomes of breast conservation and reconstruction after mastectomy using BREAST-Q

Aims: Patients’ post-operative wellbeing determines the impact and effectiveness of breast reshaping and reconstruction procedures. The aim of the study was to evaluate and compare four different types of breast reconstruction: bilateral therapeutic mammaplasty, DIEP flap, ELD with immediate lipomodelling and implant-based reconstruction using BREAST-Q. Methods: Patients who underwent breast reconstruction by one of the above-mentioned methods were identified from a retrospective register and sent BREAST-Q questionnaires. Univariate and multivariate analysis of BREAST-Q scores and clinical characteristics were performed for identifying trends between and within groups. Results: A total of 240 patients were identified with a response rate of 57%. Patients receiving implants were statistically less satisfied with breast reconstruction (mean 57%) and tended to be younger with lower BMI in comparison to other groups. There were no statistical differences in psychosocial wellbeing or patient experience between groups. Despite the fact that clinically these groups were heterogeneous, satisfaction with breast was similar in the remaining three autologous groups (range 70–75%). Detailed analysis and interpretation of quality-of-life scores, clinical differences and trends identified in the multivariate analysis along with nuances between surgical techniques used in our unit for breast reshaping and reconstruction, have been performed. Conclusions: The most important goal of breast reconstruction is to restore patients’ quality of life and satisfaction with breast. Identifying factors which can potentially predict poor outcomes will improve the informed consent process and patient selection.