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2008 Annual Meeting Abstracts

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Prospective Analysis of Long-Term Psychosocial Outcomes in Breast Reconstruction: Two-Year Postoperative Results from the Michigan Breast Reconstruction Outcomes Study
Dunya M. Atisha, M.D.1, Amy K. Alderman, M.D., M.P.H.1, Julie Lowery, PhD2, Latoya E. Kuhn, M.P.H.2, Jenny Davis, MHSA2, Edwin G. Wilkins, M.D., M.S.1.
1University of Michigan, Department of Surgery, Section of Plastic and Reconstructive Surgery, Ann Arbor, MI, USA, 2VA, HSR&D, Ann Arbor, MI, USA.

PURPOSE:
Breast reconstruction has been shown to confer significant psychosocial benefits in breast cancer patients. In a year one prospective analysis, we found these benefits to be essentially independent of procedure type and timing. Like other outcomes in breast reconstruction, we considered the possibility that psychosocial outcomes may remain in a state of flux for years after surgery. To study this, we prospectively evaluated the psychosocial outcomes of patients two years post breast reconstruction.
METHODS:
Patients were recruited as part of the Michigan Breast Reconstruction Outcome Study (MBROS), a 12 center, 23 surgeon prospective cohort study of mastectomy reconstruction patients. Two sided paired sample t-tests were used to compare change scores (difference between two years post and pre-operative scores) for the various psychosocial subscales and for body image. Multiple regression analysis was used to determine whether the magnitude of the change between year two post-operative and pre-operative scores varied by procedure type.
RESULTS:
Preoperative and postoperative year two surveys were received from 173 patients;116 patients who had immediate reconstruction and 57 who had delayed reconstruction. For the immediate reconstruction cohort, significant improvements were observed in all psychosocial subscales except for body image. This occurred essentially independent of procedure type except for the FACT-B social well being subscale. Patients with immediate free Transverse Rectus Abdominis Musculocutaneous (TRAM) flaps reported significantly greater gains in their social well being change scores compared to patients with expander/implants (p = 0.024). For patients with delayed reconstruction, only body image remained significantly higher at post-operative year two. In addition, procedure type only had an impact on body image, such that women with TRAM flaps (both pedicle and free) had significantly greater gains in body image scores (p = 0.003 and p = 0.034, respectively) compared to women with expander/implants.
CONCLUSION:
General psychosocial benefits and body image gains continued to manifest at two years post mastectomy reconstruction. In addition, procedure type had a surprisingly limited effect on psychosocial well being. With outcomes evolving beyond one year post-reconstruction, these data support the need for additional longitudinal breast reconstruction outcome studies.


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