Abstract: Analysis of Clinical Outcomes, Cosmetic Results, and Patient Satisfaction Following Delayed-Immediate Breast Reconstruction

Abstract

INTRODUCTION: Timing and aesthetic outcomes of post-mastectomy breast reconstruction may be affected by the need for radiotherapy treatment (RT), which is often unknown at the preoperative stage since it is determined by pathological findings from the mastectomy specimen. In delayed-immediate reconstruction,1 a tissue expander (TE) is placed directly after the mastectomy to preserve the skin envelope. If RT is not necessary, patients undergo definitive reconstruction. If RT is necessary, the TE remains and patients undergo final reconstruction after RT. We sought to compare the clinical outcomes, cosmetic results, and patient satisfaction of delayed-immediate autologous reconstruction (DIR) vs. delayed autologous reconstruction. METHODS: DIR patients were matched to delayed patients based on age (+/- 5 years), body mass index (BMI) (+/- 2.5), and unilateral or bilateral reconstruction. Retrospective chart review was conducted to collect clinical outcomes, independent reviewers scored cosmetic outcomes (skin quality/color, scar formation, symmetry, breast contour/size/position, overall aesthetic outcome), and patients scored their satisfaction using the BREAST-Q patient reported outcomes instrument. We further examined whether other factors such as smoking, obesity, and RT influenced cosmetic results. Statistical analyses were conducted in IBM SPSS Statistics 24. RESULTS: 19 DIR and 19 delayed patients were included. The mean patient age was 46.5 years (range 29–64) and the mean BMI was 29.6 (range 21.4–41.9). There were no differences in demographics between the two groups. 16 patients underwent unilateral reconstruction and 22 patients underwent bilateral reconstruction. DIR was associated with a higher infection rate (42.1% vs. 5.3%, p=0.026), and all infections involved the TE. DIR patients had significantly better breast contour/size/position than the delayed group (p=0.041). Further, compared to patients who received RT, those who did not receive RT demonstrated better cosmetic outcomes in terms of skin quality/color (p=0.001), symmetry (p=0.001), breast contour/size/position (p<0.001), and overall aesthetic outcome (p<0.001). There were no differences in patient satisfaction between the two groups. CONCLUSION: DIR could be an excellent choice for patients wanting autologous reconstruction when the need for radiation therapy remains unknown, as it demonstrated better breast contour/size/position as compared to the delayed group. However, patients should be informed about the higher risk of TE infection, which could influence the ultimate cosmetic result, and that patient satisfaction was ultimately the same for patients choosing either reconstructive strategy. Reference Citations: 1. Kronowitz SJ, Hunt KK, Kuerer HM, et al. Delayed-immediate breast reconstruction. Plast Reconstr Surg 2004;113:1617–28.