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2008 Annual Meeting Abstracts

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Patient Satisfaction with Breast Reconstruction: A Comparison of Saline and Silicone Implants
Colleen M. McCarthy, MD, S Cano, MD, A Klassen, MD, A M. Scott, MD, A K. Alderman, MD, P A. Lennox, MD, B M. Mehrara, MD, J D. Disa, MD, P G. Cordeiro, MD, A P. Pusic, MD.
Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

Background: At a time when the safety and effectiveness of breast implants remains under close scrutiny, it is important to provide reliable and valid evidence regarding patient outcomes. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life may be the most significant outcome variables in evaluating surgical success. For this reason, careful consideration of patient-reported outcomes is vitally important to research efforts and clinical care.
The objective of this study was to better understand the impact of implant type on patient satisfaction with breast reconstruction.
Methods: A multi-center, cross-sectional study design was employed. Women who had completed postmastectomy, implant-based reconstruction at one of three centers in North America were asked to complete the BREAST-Q© (Reconstruction Module). This questionnaire was rigorously developed and validated using internationally developed guidelines. A 15-item subscale of the BREAST-Q© was used to evaluate patients’ satisfaction with their reconstructed breasts. This subscale addresses issues such as satisfaction with breast shape, feel to the touch, appearance, feelings of “normalcy” and integration of one’s reconstructed breasts as self. Summary scores were calculated. Univariate analyses were performed. Variables significant at the 0.10 level were considered for entry into a multivariate linear regression model. The criterion to remain in the model was set to 0.05.
Results: The BREAST-Q© Reconstruction Module was administered to 672 implant reconstruction patients. Seventy-two percent (n=484) of patients completed the questionnaire at a mean 3.0 years (SD 2.0; range 0.5-17.9) from completion of reconstruction. Mean patient age was 52.9 years (SD 10.9; range 19-79). In 177 women, silicone implants were placed; in 307, saline implants were used. Results of univariate analyses suggested that long-term ‘Satisfaction with Breasts’ was significantly higher in silicone versus saline implant recipients (p=0.004). After adjusting for covariates (length of follow-up, age, timing of reconstruction, radiation, ethnicity, education, income, marital status and geographical location), the multivariate model confirmed that ‘Satisfaction with Breasts’ was significantly higher in patients with silicone implants (p=0.016). The receipt of postmastectomy radiation had a significant, negative effect on breast satisfaction (p<0.000) in both silicone and saline implant recipients. In addition, for women who received either silicone or saline implants, satisfaction diminished over time (p=0.017).
Conclusions: In the setting of postmastectomy reconstruction, patients who receive silicone breast implants report significantly higher satisfaction with the results of reconstruction than those who receive saline implants. This information can be used to optimize shared medical decision-making by providing patients with realistic postoperative expectations. In addition, these findings can be used to provide important patient advocacy data.


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