Abstract
BackgroundBreast reconstruction is associated with high levels of patient satisfaction. Previous patient satisfaction studies have been subjective. This study utilizes functional magnetic resonance imaging (fMRI) to objectively evaluate “sense of self” following deep inferior epigastric perforator (DIEP) flap breast reconstruction in an attempt to better understand patient perception.MethodsProspective fMRI analysis was performed on four patients before and after delayed unilateral DIEP flap breast reconstruction, and on four patients after immediate unilateral DIEP flap breast reconstruction. Patients were randomly cued to palpate their natural breast, mastectomy site or breast reconstruction, and external silicone models. Three regions of interest (ROIs) associated with self-recognition were examined using a general linear model, and compared using a fixed effects and random effects ANOVA, respectively.ResultsIn the delayed reconstruction group, activation of the ROIs was significantly lower at the mastectomy site compared to the natural breast (p<0.01). Ten months following reconstruction, activation of the ROIs in the reconstructed breast was not significantly different from that observed with natural breast palpation. In the immediate reconstruction group, palpation of the reconstructed breast was also similar to the natural breast. This activity was greater than that observed during palpation of external artificial models (p<0.01).ConclusionsSimilar activation patterns were observed during palpation of the reconstructed and natural breasts as compared to the non-reconstructed mastectomy site and artificial models. The cognitive process represented by this pattern may be a mechanism by which breast reconstruction improves self-perception, and thus patient satisfaction following mastectomy.
Highlights
The psychological benefits of breast reconstruction have long been touted in the plastic surgery literature, including high patient satisfaction and quality of life, improved perception of physical appearance, as well as return of a feeling of normalcy and wholeness [1,2,3,4,5]
The first analysis was between palpation of the natural breast and the mastectomy site with no reconstruction
These three regions of significantly higher activity were identified with palpation of the natural breast in contrast to light touch of the mastectomy site
Summary
The psychological benefits of breast reconstruction have long been touted in the plastic surgery literature, including high patient satisfaction and quality of life, improved perception of physical appearance, as well as return of a feeling of normalcy and wholeness [1,2,3,4,5]. Reports of post-reconstruction patient satisfaction have been subjective in nature. Functional magnetic resonance imaging (fMRI) is a noninvasive technique for measuring brain activity by detecting changes in blood oxygenation and flow that occur in response to neural activity. Breast reconstruction is associated with high levels of patient satisfaction. Previous patient satisfaction studies have been subjective. This study utilizes functional magnetic resonance imaging (fMRI) to objectively evaluate ‘‘sense of self’’ following deep inferior epigastric perforator (DIEP) flap breast reconstruction in an attempt to better understand patient perception
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