Abstract P2-19-01: Impact of breast reconstruction approach on patient-reported satisfaction with cosmetic outcomes after mastectomy with and without radiotherapy

Abstract

Abstract Background: The optimal approach to combining breast reconstruction with post-mastectomy radiation (RT) remains hotly debated. We evaluated the comparative effectiveness of different approaches using patient-reported outcomes from a longitudinal survey of patients identified through population-based registries. Methods: We conducted a multicenter cohort study of women diagnosed with stage 0-III breast cancer from 2005-07, as reported to the Los Angeles and Detroit SEER registries. We surveyed 2290 women approximately 9 months after diagnosis and again after 4 years (n = 1536). The primary dependent variable was a composite measure of satisfaction with the cosmetic outcomes of reconstruction derived from 5 items (range 1-5; Cronbach's alpha 0.91). A linear regression model evaluated the impact of reconstruction type and timing, as well as interaction with RT, controlling for age, education, and marital status, after selection from a variety of sociodemographic and clinical variables (race/ethnicity chemotherapy, contralateral mastectomy, cancer stage, comorbidities, smoking, body-mass index, bra cup size, and geographic site). Results: Of the 1450 patients who responded to both surveys and had not recurred, 222 received mastectomy and reconstruction, of whom 201 had complete variable information. There were 53 patients who had RT (among whom 53% had autologous technique and 47% had delayed timing) and 148 who did not (among whom 23% had autologous technique and 29% had delayed timing). Patients who received autologous reconstruction vs implants reported higher cosmetic satisfaction. Receipt of RT was associated with lower satisfaction. The adjusted scaled satisfaction score was 4.39 for patients receiving autologous reconstruction without RT, 4.09 for patients receiving autologous reconstruction and RT, 3.86 for patients receiving implant reconstruction without RT, and 2.71 for patients receiving implant reconstruction and RT. Patients who received RT and implant-based reconstruction had significantly lower satisfaction than the other 3 groups. Timing of reconstruction was not significantly associated with satisfaction, nor was there a significant interaction between timing and RT. Linear Regression Model of Satisfaction with Reconstruction Outcomes (n = 201)CharacteristicCoefficient95% CIpIntercept3.86(3.37,4.35)<0.001Recon type & RT status <0.001Autologous, no RT0.53(0.06,1.00) Autologous with RT0.23(-0.30,0.75) Implant, no RT00 Implant with RT-1.15(-1.84,-0.47) Reconstruction timing 0.97Immediate0.009(-0.44,0.45) Delayed00 Age (centered on 60)-0.02(-0.05, -0.001)0.04Married/partnered 0.06Yes-0.40(-0.82,0.02) No00 Education 0.35HS or less-0.23(-0.70,0.24) Some college-0.32(-0.77,0.13) College or more00 Conclusions: In patients undergoing post-mastectomy RT, use of autologous reconstruction may mitigate some of the deleterious impact on cosmetic outcomes, but this requires confirmation in a larger dataset. This study had limited power to evaluate whether delaying reconstruction preferentially benefits radiated patients. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-01.