BREAST-Q Scores Research Articles

D33. Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes

PURPOSE: Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Following explantation, patients have different reconstructive options, however data on safety and patient-reported outcomes (PROs) is limited. We aimed to 1) characterize the safety of surgical interventions for textured implant management and, 2) compare PROs across intervention groups using BREAST-Q scores. METHODS: We retrospectively reviewed patients who sought surgical intervention for textured implants between January 2018 and June 2021 and defined four management cohorts: 1) textured to smooth conversion in asymptomatic patients; 2) textured to smooth conversion in symptomatic patients, 3) explantation without replacement; and 4) textured to autologous conversion. RESULTS: We included 384 patients: 224 in the first cohort, 83 in the second, 44 in the third, and 33 in the fourth. We observed a difference in complication rates between management groups (p = 0.034), with patients undergoing explantation enduring the greatest complication rate, however we found no difference based on extent of capsulectomy. A subgroup PRO analysis, including 239 patients, showed patients converting to smooth implants or to autologous reconstruction had significantly higher satisfaction with their breasts postoperatively (p<0.05). The autologous group also had significantly improved sexual well-being 6 months and 1+ years postoperatively (p=0.005, p=0.043). CONCLUSION: Patients seeking surgical management for textured implants have acceptable rates of surgical complications. The data challenges the paradigm that complete capsulectomy is associated with increased complication rate and highlights postoperative satisfaction and well-being. This can guide patients considering surgical management and open a dialogue for shared decision making.

54. Assessing Long Term Outcomes in Prepectoral Versus Subpectoral Alloplastic Breast Reconstruction

PURPOSE: Tissue expanders (TEs) and implants can be placed using a subpectoral or prepectoral approach. At this time, long term data is needed to more effectively interpret the differences in clinical and patient reported outcomes (PROs) between prepectoral and subpectoral reconstruction. METHODS: We retrospectively reviewed female patients who underwent TE exchange to implants from 2017 to 2020. Patients had subpectoral or prepectoral reconstruction, along with preoperative and/or 1-2-year postoperative BREAST-Q data. We assessed PROs and complication rates with null hypothesis testing (significant: p<0.05). RESULTS: 2116 patients were included: 1797 subpectoral and 319 prepectoral. Regarding BREAST-Q scores, prepectoral patients had significantly higher scores than subpectoral patients for physical well-being of the chest preoperatively (p<0.001) and at 1-2-years postoperatively (p=0.003) and for satisfaction with breasts scores at 1-2-years postoperatively. Complications were low overall, but patients with prepectoral devices were more likely to get an infection, seroma, or wound dehiscence (p<0.001, p<0.001, p=0.009, respectively). In a subgroup analysis of radiated patients (neoadjuvant or adjuvant) (n =508; 464 subpectoral, 44 prepectoral), there was no difference between BREAST-Q scores of subpectoral and prepectoral patients. Patients with prepectoral devices were more likely to be affected by seromas (p=0.004) or wound dehiscence (p=0.020). CONCLUSION: Our preliminary analysis shows that, among patients undergoing alloplastic breast reconstruction, PROs are superior following prepectoral placement. However, the complication profile slightly favors subpectoral reconstruction. Additional long-term analyses should be conducted to better assess the differences between the prepectoral and subpectoral technique.

D110. Single Assessment Numeric Evaluation Score as a Simplified Measure Of Patient Satisfaction following Breast Reconstruction

PURPOSE: Patient reported outcome measures (PROM) that can be efficiently employed after breast reconstruction are being investigated as an alternative to the validated Breast-Q survey to yield valuable data without survey fatigue. The Single Assessment Numeric Evaluation (SANE) has been used to rate function after orthopedic surgery but has not been extrapolated to functional and aesthetic outcomes after breast reconstruction. METHODS: 255 patients 1-3 years after breast reconstruction were contacted to complete both the SANE and Breast-Q Post-op Module for aesthetic and functional outcomes respectively. Demographics, comorbidities, treatment and surgical characteristics were reported and Pearson Correlation between survey mechanisms was evaluated. RESULTS: 91 patients completed both surveys with a mean aesthetic SANE score of 60.6 ± 28.0, and mean Aesthetic Breast-Q score of 61.4 ± 19.8 showing a strong correlation between the two surveys for aesthetic outcome (R = 0.76, P <0.001). The mean function SANE score 74.7 ± 26.4, and the mean functional Breast-Q was 74.0 ± 21.5 with a strongly positive correlation (R = 0.532, P <0.001). The SANE scores also provided a comparison with non-operated contralateral breasts in unilateral cases showing higher scores for the contralateral native breast for both appearance and function. CONCLUSION: The SANE scoring tool when applied to breast reconstruction outcomes correlated strongly with the validated Breast-Q for both functional and aesthetic outcomes. Application of this efficient PROM to greater patient numbers will demonstrate its utility for patients undergoing different cancer treatment regimens as well as its performance as a repeated measure.

PC41. Sexual Well-being in Patients with Breast Cancer Surgery: Trends, Associated Factors, and Interventions

PURPOSE: Sexual well-being is the third most common concern reported by breast cancer patients, but often overlooked in postoperative survivorship. This study aims to understand sexual well-being in breast cancer patients, including the trend, associated factors, and interventions. METHODS: We analyzed patients who underwent post-mastectomy breast reconstruction or lumpectomy and completed the BREAST-Q sexual well-being module between 2010 and 2021. We compared sexual well-being in reconstruction and lumpectomy patients over time, delineated associated factors, and evaluated the incidence and impact of sexual medicine consultation. RESULTS: 16,061 lumpectomy and breast reconstruction patients were included. Reconstruction patients had consistently lower sexual well-being than lumpectomy patients, from preoperative to 5-year follow-up (p<0.001). In reconstruction, factors associated with lower sexual well-being at 1-year included separated/single marital status, higher BMI, postmenopausal status, and psychiatric disorders (p<0.05). Patients with more advanced cancer, axillary dissection, and skin-sparing mastectomy (vs. nipple-sparing) had lower sexual well-being. Overall, 5.5% of reconstruction patients received a sexual medicine consultation. Patients who received the consultation were younger, from lower income bracket, underwent lymph node dissection, and had lower preoperative scores than those without consultation (p<0.05). BREAST-Q scores improved from 36.4±21.5 to 41.3±19.5 (p=0.004) following intervention. CONCLUSION: Decreased sexual well-being is imperative to consider in breast reconstruction patients, particularly among those who are separated/single or have psychiatric disorders and advanced cancer. Only a small fraction of patients receives sexual medicine consultation, yet such intervention improves patients’ sexual health. Providers should assess sexual well-being in breast reconstruction and refer for sexual medicine consultations when appropriate.

Patient Satisfaction Using Breast-Q After Breast Reconstruction in Male-to-Female Transgender Patients

Abstract Goals/Purpose Male-to-female top surgery comprises an increasing portion of breast augmentations performed by plastic surgeons across the nation. Many studies have been performed in cis-females reporting improved overall satisfaction with their breasts, as well as improved psychosocial, sexual, and physical well-being utilizing the validated BREAST-Q questionnaire. Satisfaction in this transgender population has not been well studied using the current standard of care in the United States, non-textured implants. The authors conducted a retrospective study following male-to-female patients who received non-textured implants as part of their breast reconstruction. Methods/Technique The authors searched electronic medical records for patients aged 18 years or older who underwent breast augmentation for male-to-female top surgery at Denver Health Medical Center between 2018 and 2021. Survey evaluation using the validated BREAST-Q questionnaire was administered via telephone or in clinic at 6 months and 1 year after breast implant placement. Breast-Q scores for psychosocial, sexual, physical well-being, satisfaction with breasts, and overall post-satisfaction subscales were collected and converted to the equivalent Rasch transformed score. Because this was a retrospective study, median pre-operative subscale scores were utilized from another study that looked at satisfaction in the use of anatomical textured implants in transgender patients by Weigert et al. These pre-operative median scores were compared with patient scores at 6 and 12 months post-operatively. Results/Complications 30 male-to-female transgender patients were contacted to participate in this study. 24 patients volunteered to participate, and 6 declined. BREAST-Q survey results demonstrate significantly improved satisfaction post-operatively at 6 and 12 months when compared to median pre-operative scores for psychosocial (p &amp;lt;0.001; p &amp;lt;0.001), sexual (p&amp;lt;0.001; p &amp;lt;0.001), physical well-being (p&amp;lt;0.001; p &amp;lt;0.001), and satisfaction with breasts (p&amp;lt;0.001; p &amp;lt;0.001). Results demonstrate that some subscales of post-operative satisfaction increased with more time from surgery. Between 6 and 12 months post-operatively, patients experienced significant improvement in physical (p&amp;lt;0.001), sexual (p&amp;lt;0.007), and psychosocial well-being (p&amp;lt;0.019). No significant change was seen in satisfaction with outcome or satisfaction with breast between 6 and 12 months. Conclusion Male-to-female transgender patients exhibit a significant increase in satisfaction following breast augmentation when assessed using the validated BREAST-Q questionnaire. Counseling this patient population pre-operatively, providers can use these results to better advise patients and set reasonable post-operative expectations. Further studies investigating long-term satisfaction in larger cohorts are needed.

Prevention of Postoperative Complications by Prepectoral versus Subpectoral Breast Reconstruction: A Systematic Review and Meta-Analysis.

Implant-based breast reconstruction has evolved over time. However, the effects of prepectoral breast reconstruction (PBR) compared with those of subpectoral breast reconstruction (SBR) have not been clearly defined. Therefore, this study aimed to compare the occurrence of surgical complications between PBR and SBR to determine the procedure that is effective and relatively safe. The PubMed, Cochrane Library, and EMBASE databases were searched for studies published until April of 2021 comparing PBR and SBR following mastectomy. Two authors independently assessed the risk of bias. General information on the studies and surgical outcomes were extracted. Among 857 studies, 34 and 29 were included in the systematic review and meta-analysis, respectively. Subgroup analysis was performed to clearly compare the results of patients who underwent postmastectomy radiation therapy. Pooled results showed that prevention of capsular contracture (OR, 0.57; 95% CI, 0.41 to 0.79) and infection control (OR, 0.73; 95% CI, 0.58 to 0.92) were better with PBR than with SBR. Rates of hematoma, implant loss, seroma, skin-flap necrosis, and wound dehiscence were not significantly different between PBR and SBR. PBR considerably improved postoperative pain, BREAST-Q score, and upper arm function compared with SBR. Among postmastectomy radiation therapy patients, the incidence rates of capsular contracture were significantly lower in the PBR group than in the SBR group (OR, 0.14; 95% CI, 0.05 to 0.35). The results showed that PBR had fewer postoperative complications than SBR. The authors' meta-analysis suggests that PBR could be used as an alternative technique for breast reconstruction in appropriate patients.

Abstract P4-05-02: oncoplastic breast surgery and involvement of plastic surgery improve quality of life by Breast-Q score in breast conserving surgery

Abstract Introduction: Breast cancer surgery is a life altering event which can have profound consequences on a woman’s physical, mental and emotional health. Breast Surgery creates cosmetic changes which can harm a woman’s emotional well-being and quality of life. Breast reconstruction following mastectomy has been found to improve many quality of life measures and has been well studied. This has been less well studied in breast conserving surgery. The addition of oncoplastic breast surgical techniques and involvement of a plastic surgeon for immediate reconstruction following partial mastectomy can improve the cosmetic outcome for patients, reduce synptoms of breast hypertrophy and improve quality of life. To assess this, we applied the Breast Q scale before and after surgery and found a significant improvement in multiple quality of life indices. Methods: Between January 2020 through May 2022, 136 women undergoing breast conservation were given the Breast Q Version 2.0 Breast conserving therapy module (pre-and postoperative scales) written questionnaire before and again between 3 and 6 months after surgery. The Breast Q survey is a standard tool used by surgeons to assess a variety of quality of life factors following breast surgery. The patients were prospectively studied but not randomized in any specific way. The surgical technique used for the procedure was determined by a discussion between the patient and her breast surgeon. Results were divided into groups based on type of surgery and differences between groups with respect to the Breast-Q questions were analyzed with the student T test for p values. Results: Patients were divided into three categories; simple closure, the control group (20% n=26), oncoplastic closure with internal tissue rearrangement greater than 10 cm² (60% n=79) and patients who had involvement of a plastic surgeon for therapeutic mammaplasty and contralateral symmetry procedure (25% n=31). Significant improvement (p&amp;lt;.05) over the control arm and patients undergoing standard oncoplastic closures without a plastic surgeon was noted in several areas. These include an increase in confidence in a social setting, acceptance of her body, overall attractiveness, overall emotional health, sexual confidence and comfort wearing clothing and/or bra. Relative to the control group, the addition of oncoplastic closure also showed significant improvement in scores over patients without these techniques although the magnitude was smaller than with the use of a plastic surgeon. Conclusion: In breast conserving surgery, the addition of oncoplastic closure and especially the involvement of a plastic surgeon for therapeutic mammaplasty is highly effective at limiting some aspects of the deficits in quality of life and, surprisingly, significantly improved this from baseline in many patients. Where appropriate, these techniques should be employed to enhance individual patients quality of life.. Citation Format: Michael E. Stuntz, Tamara A. Rychkov, Jenna Garcia. oncoplastic breast surgery and involvement of plastic surgery improve quality of life by Breast-Q score in breast conserving surgery [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-05-02.

Effect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer

There is a need for a new, less invasive breast reconstruction option for patients who undergo mastectomy in their breast cancer treatment. To investigate quality of life (QoL) among patients undergoing a new breast reconstruction technique, autologous fat transfer (AFT), compared with that among patients undergoing implant-based reconstruction (IBR). The BREAST trial was a randomized clinical trial conducted between November 2, 2015, and October 31, 2021, performed in 7 hospitals across the Netherlands. Follow-up was 12 months. Referrals could be obtained from general practitioners and all departments from participating or nonparticipating hospitals. The patients with breast cancer who had undergone mastectomy and were seeking breast reconstruction were screened for eligibility (radiotherapy history and physique) by participating plastic surgeons. Patients receiving postmastectomy radiotherapy were excluded. Breast reconstruction with AFT plus expansion or 2-phased IBR. Randomization was done in a 1:1 ratio. The statistical analysis was performed per protocol. The predefined primary outcome was QoL at 12 months after final surgery. This was measured by the BREAST-Q questionnaire, a validated breast reconstruction surgery questionnaire. Questions on the BREAST-Q questionnaire are scored from 0 to 100, with a higher score indicating greater satisfaction or better QoL (depending on the scale). Secondary outcomes were breast volume and the safety and efficacy of the techniques. A total of 193 female patients (mean [SD] age, 49.2 [10.6] years) 18 years or older who desired breast reconstruction were included, of whom 91 patients in the AFT group (mean [SD] age, 49.3 [10.3] years) and 80 in the IBR group (mean age, 49.1 [11.0] years) received the allocated intervention. In total, 64 women in the AFT group and 68 women in the IBR group completed follow-up. In the IBR group, 18 patients dropped out mainly due to their aversion to implant use while in the AFT group 6 patients ended their treatment prematurely because of the burden (that is, the treatment being too heavy or tiring). The BREAST-Q scores were higher in the AFT group in all 5 domains and significantly higher in 3: satisfaction with breasts (difference, 9.9; P = .002), physical well-being: chest (difference; 7.6; P = .007), and satisfaction with outcome (difference, 7.6; P = .04). Linear mixed-effects regression analysis showed that QoL change over time was dependent on the treatment group in favor of AFT. The mean (SD) breast volume achieved differed between the groups (AFT: 300.3 [111.4] mL; IBR: 384.1 [86.6] mL). No differences in oncological serious adverse events were found. This randomized clinical trial found higher QoL and an increase in QoL scores over time in the AFT group compared with the IBR group. No evidence was found that AFT was unsafe. This is encouraging news since it provides a third, less invasive reconstruction option for patients with breast cancer. ClinicalTrials.gov Identifier: NCT02339779.

Abstract P4-07-13: Satisfaction of patients after implant-based subpectoral reconstruction with a titanized polypropylene mesh (TiLOOP® Bra) compared to prepectoral reconstruction with a titanzied polypropylene pocket (TiLOOP® Bra Pocket)

Abstract Introduction Patients’ satisfaction after breast reconstruction can be evaluated with validated questionnaires as the Breast-Q questionnaire. The Breast-Q questionnaire includes different domains; one of them is “satisfaction with the result”. Material and methods: In the multicentre, prospective studies PRO (patient related outcome)-BRA (clinicaltrials.gov: NCT01885572) and PRO-Pocket (clinicaltrials.gov: NCT03868514), patient satisfaction was assessed using the Breast-Q questionnaire. In the PRO-Bra study, 269 patients underwent subpectoral surgery using the TiLOOP® Bra polypropylene mesh (pfm medical ag, Germany). In the "PRO-Pocket" study, 311 patients underwent prepectoral surgery using the TiLOOP® Bra Pocket polypropylene mesh. For the evaluation, those patients from the PRO-Bra and PRO-Pocket studies who completed a Breast-Q questionnaire 6 and/or 12 months after surgery were included. The BreastQ score is measured from 0 to 100, with a score of 100 corresponding to "very satisfied". Satisfaction with the result of the breast reconstruction was evaluated. Results: In the PRO-Bra study, a total of 221 and 203 patients completed a Breast-Q at 6 months and/or 12 months FU, respectively. The mean age and BMI of the patients with completed Breast-Q were comparable between the two studies (PRO-Bra: 49.3 [±11.6] years, 22.9 kg/m2 [±3.5]; PRO-Pocket: 47.7 [±11.7] years, 24.5 kg/m2 [±4.3]). In the PRO-Pocket study, a total of 258 and 266 patients completed a Breast-Q at 6 months and/or 12 months FU, respectively. In the PRO-Bra study the mean score of satisfaction with the result at 6 months follow-up (FU) was 74.5 (±19.9), in the PRO-Pocket 79.1 (±19.1), at 12 months FU the mean scores were 76.3 (±18.9) for PRO-Bra and 78.2 (±20.4) for PRO-Pocket. Furthermore, stratification according to age (cutoff 50 years) or BMI (cutoff 25 kg/m2) did not reveal any differences between the subgroups or the two studies (see Table). PRO-Bra PRO-Pocket mean score (±SD) 6 months 12 months 6 months 12 months BMI ≤ 25 75.1 (±19.7) 76.4 (±17.8) 77.7 (±19.9) 78.9 (±19.8) BMI &amp;gt; 25 72.1 (±20.7) 76.1 (±22.9) 82.1 (±16.9) 76.8 (±21.8) age ≤ 50 76.4 (±18.7) 77.0 (±18.9) 80.1 (±18.7) 78.1 (±19.6) age &amp;gt; 50 71.5 (±21.5) 75.3 (±19.0) 77.5 (±19.5) 78.4 (±21.8) Conclusion: Our data so far show high patient satisfaction with overall outcome of the surgery. In addition, patients’ satisfaction with the result was comparable after subpectoral as well as prepectoral implant placement. This is particularly important in the PRO-Pocket study, as approximately 60% of the operations and the follow-up period took place during the COVID-19 pandemic. Citation Format: Stefan Paepke, Anne Andrulat, Christine Ankel, Lelia Bauer, Kristin Baumann, Jens-Uwe Blohmer, Andree Faridi, Visnja Fink, Claudia Gerber-Schaefer, Daphne Gschwantler-Kaulich, Jörg Heil, Sherko Kuemmel, Anette Kossmann-Meiré, Ralf Ohlinger, Marc Thill. Satisfaction of patients after implant-based subpectoral reconstruction with a titanized polypropylene mesh (TiLOOP® Bra) compared to prepectoral reconstruction with a titanzied polypropylene pocket (TiLOOP® Bra Pocket) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-13.

Abstract P2-15-05: Prepectoral versus subpectoral implant-based breast reconstruction: A systemic review and meta-analysis

Abstract Prepectoral versus subpectoral implant-based breast reconstruction: A systemic review and meta-analysis. Edvin Ostapenko, MD1,2, Larissa Nixdorf, MD1, Yelena Devyatko, MD1, Ruth Exner, MD1, Kerstin Wimmer, MD1, Florian Fitzal, MD1 1Department of General Surgery and Breast Health Center, Medical University of Vienna, Vienna, Austria. 2Faculty of Medicine, Vilnius University, Vilnius, Lithuania Abstract Background Implant-based breast reconstruction (IBBR) is still standard and most popular option for women undergoing breast reconstruction after mastectomy worldwide. Recently, prepectoral IBBR has resurged in popularity, despite limited data comparing prepectoral with subpectoral IBBR. Methods A systematic search of PubMed and Cochrane Library from January 1, 2011, to December 31, 2021, was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guideline, data were extracted by independent reviewers. Random and fixed-effect models were applied to obtain pooled proportions and 95% CIs. The Risk of Bias in Nonrandomized Studies- of Interventions (ROBINS-I) tool was used for critical appraisal of cohorts and funnels plots, and the Egger bias test were used for evaluating the publication bias. Studies that compared prepectoral IBBR with subpectoral IBBR for breast cancer were included. Results Overall, 15 studies with 3101 patients were included in this meta-analysis. Our results showed that patients receiving prepectoral IBBR experienced fewer capsular contracture (odds ratio [OR], 0.54; 95% CI, 0.32-0.92; P=.02), animation deformity (OR, 0.02; 95% CI, 0.00-0.25; P=.002), and prosthesis failure (OR, 0.58; 95% CI, 0.42-0.80; P=.001). There was no significant difference between prepectoral and subpectoral IBBR in overall complications (OR, 0.83; 95% CI, 0.64-1.09; P=.19), seroma (OR, 1.21; 95% CI, 0.59-2.51; P=.60), hematoma (OR, 0.76 95% CI, 0.49-1.18; P=.22), infection (OR, 0.87; 95% CI, 0.63-1.20; P=.39), skin flap necrosis (OR, 0.70 95% CI, 0.45-1.08; P=.11), and recurrence (OR, 1.31; 95% CI, 0.52-3.39; P=.55). Similarly, no significant difference was found in Breast-Q scores between prepectoral and subpectoral IBBR groups. Conclusion The results of our systematic review and meta-analysis demonstrated that prepectoral implant-based breast reconstruction is a safe modality and have similar outcomes with significantly lower rates of capsular contracture, prosthesis failure and animation deformity compared to subpectoral implant-based breast reconstruction. Future research should include randomized clinical trials or well-designed prospective matched studies with adequate follow-up to assess long-term as well as oncologic outcomes between comparative groups. Key Words: immediate implant-based breast reconstruction, breast cancer, outcomes, prepectoral, subpectoral; Citation Format: Edvin Ostapenko, Larissa Nixdorf, Yelena Devyatko, Kerstin Wimmer, Ruth Exner, Florian Fitzal. Prepectoral versus subpectoral implant-based breast reconstruction: A systemic review and meta-analysis. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-15-05.

BREAST-Q and Donor Site Comparison in Bilateral Stacked Autologous Breast Reconstruction

Introduction: Patients undergoing bilateral autologous breast reconstruction may benefit from increased flap volume using bilateral stacked deep inferior epigastric perforator (DIEP) and profunda artery perforator (PAP) flaps. Our aim was to characterize the donor site morbidity and patient reported outcomes in four-flap breast reconstruction. Materials and Methods: Retrospective review was performed for all patients undergoing four-flap breast reconstruction by two surgeons between January 2010 – September 2021. Outcome measures including the BREAST-Q reconstructive module, the Lower Extremity Functional Scale (LEFS), inpatient surgical site pain scores by Numeric Pain Rating Scale (NPRS), and a post-operative subjective survey comparing donor sites were obtained. Four-flap BREAST-Q scores were compared to bilateral DIEP and to bilateral PAP patients. Results: A total of 79 patients undergoing four-flap breast reconstruction were identified. Four-flap BREAST-Q scores (n=56) were similar to bilateral DIEP and bilateral PAP reconstruction patients. Long term survey outcomes from the LEFS demonstrated improved score trend after 6 months. Mean instances of donor site pain location recorded at the abdomen were significantly higher than the thigh during the post-operative admission. Subjective survey data revealed more long-term donor site pain at the PAP site, a patient preference for the DIEP donor site, and easier post-operative care for the DIEP donor site. Conclusion: This is the largest consecutive series of four-flap breast reconstruction outcomes reported to date. BREAST-Q scores in four-flap patients demonstrate overall patient satisfaction that is similar to both bilateral DIEP and bilateral PAP reconstruction patients. The DIEP donor site appears to be preferred by patients than the PAP donor site.

Abstract P1-09-08: Comparisons of aesthetic outcomes and prognosis of conventional breast conserving surgery, oncoplastic breast conserving surgery and breast conserving surgery plus immediate lipofilling in early breast cancer

Abstract Background: Conventional breast conserving surgery (CBCS) considered as a confined alternative to mastectomy could lead to potentially breast deformities. Oncoplastic breast conserving surgery (OBCS) as well as breast conserving surgery (BCS) plus immediate lipofilling have been shown to be reliable techniques for maintaining the natural breast contours, however, few studies compared those three surgical options for oncological safety, complications and aesthetic outcomes in early breast cancer (EBC). Methods: We retrospectively reviewed the data of BC patients who underwent BCS between January 2017 and December 2021 from The First Affiliated Hospital of Chongqing Medical University. We included female patients who received BCS for unilateral stage 0-III BC. Those who had bilateral BC, incomplete surgical records, unfinished adjuvant therapy, multiple primary malignant tumors and lost to follow-up and were excluded. Patient-reported outcome measures (PROMs) were assessed using the BREAST-Q Version 2.0. We utilized a multivariable linear regression model to identify clinical factors correlated with the BREAST-Q score, and the log-rank test and Cox regression models were used to compare the survival difference between groups. Results: Of 268 patients, 90 (33.6%) underwent CBCS, 53 (19.8%) underwent OBCS and 125 (46.6%) underwent BCS plus immediate lipofilling. Patients in OBCS and BCS plus immediate lipofilling groups were younger than those in CBCS group (mean age: 43.9yrs vs 49.1yrs, P=0.001 and 45.7yrs vs 49.1yrs, P=0.008). The largest tumor size and heaviest BCS specimen were observed in the OBCS group compared with CBCS (mean tumor size: 23.4mm vs 17.3mm, P&amp;lt; 0.001 and median excised weight: 122.0g vs 36.5g, P&amp;lt; 0.001) and BCS plus immediate lipofilling group (mean tumor size: 23.4mm vs 17.4mm, P&amp;lt; 0.001 and median excised weight: 122.0g vs 37.0g, P&amp;lt; 0.001). It was balanced for pathological type, Ki-67, ER and PR expression between three groups. In the multivariable linear regression models, with the CBCS group as referent, either OBCS or BCS plus immediate lipofilling groups had a significantly higher score in satisfaction with breast (Estimate: 9.27, P=0.001 and Estimate: 13.08, P&amp;lt; 0.001) and psychosocial well-being (Estimate: 6.06, P=0.021 and Estimate: 9.34, P&amp;lt; 0.001). Additionally, sexual well-being was improved among patients receiving BCS plus immediate lipofilling (Estimate: 6.19, P=0.029). Nevertheless, patients in OBCS group harbored worse physical well-being compared with CBCS (Estimate: -15.89, P&amp;lt; 0.001). There was no significantly statistical difference among three groups on re-excision rate (P=0.721) and postoperative complications (P=0.663). After 37-month median follow-up, identical event-free survival (EFS) was revealed among three groups (HROBCS vs CBCS: 3.93; 95%CI, 0.78-19.81, P=0.098; HRBCS plus Lipofilling vs CBCS: 1.15, 95%CI, 0.28-4.67, P=0.847). Conclusion: This study demonstrated that OBCS as well as BCS plus immediate lipofilling shared equivalent oncological safety but better cosmetic outcomes and patient satisfaction when compared with CBCS for EBC patients, suggesting that further prospective randomized clinical trials are warranted to confirm our findings. Citation Format: JH Ren, Yuanyuan Wang, Xiang Zhang, Kang Wang, Renxi Tang, Ling Yang, Junge Gong, Jiawei Xu, Qing Li, WM Zhu, Qiao Cheng, Guosheng Ren, Hongyuan Li. Comparisons of aesthetic outcomes and prognosis of conventional breast conserving surgery, oncoplastic breast conserving surgery and breast conserving surgery plus immediate lipofilling in early breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-09-08.

Autologous Breast Reconstruction after Massive Weight Loss: Understanding Risks in a Growing Population.

Massive weight loss (MWL) may have suboptimal effects on tissues used for autologous reconstruction. With the rising rates of obesity and bariatric surgery, more patients who have experienced MWL will be presenting for breast reconstruction. The authors hypothesize that autologous breast reconstruction in patients with a history of MWL will have more complications and require more revisions compared with reconstruction in patients without a history of MWL. A retrospective review was performed on patients who underwent autologous breast reconstruction by five microsurgeons at an academic institution from 2009 through 2020. Patients with a history of bariatric surgery or greater than 50-pound weight loss were identified and compared with patients who had not experienced MWL. Analysis compared demographics, operative details, complications, revision rates, and BREAST-Q scores. Of 916 patients who underwent 1465 flaps, 39 patients with MWL (4.3%) underwent 68 flaps (4.6%), and 877 patients without MWL underwent 1397 flaps. MWL patients were more likely to require blood transfusions postoperatively ( P = 0.005); experienced more surgical-site infections ( P = 0.02), wound-healing complications of flap ( P = 0.007) and donor sites ( P = 0.03), and late partial flap losses ( P = 0.03); and required more revisional surgery for flap ( P = 0.009) and donor sites ( P = 0.01). BREAST-Q scores were not statistically different for satisfaction with breasts or surgeon but were lower in MWL patients for psychosocial ( P = 0.01) and sexual well-being ( P = 0.04). Reconstructive surgeons should expect increased postoperative complications when performing autologous breast reconstruction in patients who have experienced MWL. These patients should be counseled on the possibility of an increased risk of postoperative complications and need for revisional surgery. Risk, II.

Replacing an Implant-Based with a DIEP Flap Breast Reconstruction: Breast Sensation and Quality of Life.

In this cohort study, the authors compared breast sensation and quality of life (QoL) after replacement of an implant-based breast reconstruction with a deep inferior epigastric perforator (DIEP) flap reconstruction in a singular sample of women. Women with implant-based breast reconstruction before their DIEP flap were included. Women formed their own control. Breast sensation was measured using Semmes-Weinstein monofilaments. QoL was evaluated using BREAST-Q questionnaires. Preoperative (T0) sensation and QoL were compared with postoperative values at 6 months (T1), at 12 months (T2), and at maximum follow-up (Tmax, sensation only). A linear mixed effects regression was used for Semmes-Weinstein monofilaments measurements; a paired samples t test was used for BREAST-Q scores. Most women chose replacement of their implant by a DIEP flap because of implant-related complaints. Postoperative sensation decreased significantly compared with preoperative sensation after T1 (mean, 5.1 months), T2 (mean, 14.6 months), and Tmax (mean, 17.6 months) for the total breast but recovers to preoperative levels for the native skin after an average of 1.5 years. Nerve coaptation positively influenced recovery of sensation. BREAST-Q scores increased significantly after 6 and 12 months over the domains Satisfaction with Breasts, Psychosocial Well-Being, Physical Well-Being of the Chest, and Sexual Well-Being. Scores decreased significantly in Physical Well-Being of the Abdomen after 6 months. Replacing an implant with a DIEP flap initially causes a decrease in overall breast sensation, gradually recovering to preoperative levels for native skin, and can significantly increase QoL with the right indication. Superior recovery of sensation and QoL may be obtained by accompanying the DIEP flap with nerve coaptation. Therapeutic, IV.

Interpreting the BREAST-Q for Breast-Conserving Therapy: Minimal Important Differences and Clinical Reference Values.

The BREAST-Q is an important tool for evaluating patient satisfaction and quality of life in breast-conserving therapy (BCT) patients, but its clinical utility is limited by the lack of guidance on score interpretation. This study determines reference values and the minimal important difference (MID) for the BREAST-Q BCT module. A retrospective review of BCT patients at Memorial Sloan Kettering Cancer Center from January 2011 to December 2021 was performed. Descriptive statistics were used to summarize median BREAST-Q scores. Distribution-based analyses estimated MIDs based on 0.2 standard deviation of baseline BREAST-Q scores and 0.2 standardized response mean of the difference between baseline and 1-year postoperative BREAST-Q scores. MIDs for different clinical groupings based on body mass index, radiation, and reexcision also were estimated. Overall, 8060 patients were included for determining reference values, and 5673 patients were included for estimating MIDs. Median BREAST-Q scores trended upwards and stabilized by 2years after surgery for all domains except Physical Well-Being of the Chest, which decreased and stabilized by 2years. A score interpretation tool, the Real-Time Engagement and Communication Tool, was created based on 25th percentile, median, and 75th percentile scores trajectories. All MID estimates ranged from 3 to 5 points; 4 points was determined to be appropriate for use in clinical practice and research. Reference values and MIDs are crucial to BREAST-Q score interpretation, which can lead to improved clinical evaluation and decision making and improved research methodology. Future research should validate this study's findings in different patient cohorts.

Postmastectomy Immediate Implant-Based Breast Reconstruction with Scarless Latissimus Dorsi Flap-a Simple and Versatile Technique.

In low- and middle-income countries, breast reconstruction is not widely practiced due to a lack of specialized equipment, skilled personnel, and high costs. The scarless latissimus dorsi flap is a useful technique which can harvest a major portion of the latissimus dorsi muscle using the same mastectomy incision without requiring repositioning of the patient, to cover the lower pole of prosthesis for reconstruction. The aim of this study was to assess and evaluate the cosmetic results and complications of scarless LD flap used as a lower pole cover in post-mastectomy breast reconstruction with implants. This is a pilot study of 18 breast cancer patients who underwent implant-based scarless LD flap breast reconstructions during a period of 4years from 2017 to 2021. A questionnaire based on relevant subscales of BREAST-Q scores was completed by all the patients and used for evaluation. A total of 18 patients who underwent 20 surgeries were evaluated for the study. The median age was 44.5years. The mean operative time was observed to be 164.50min. The mean length of hospital stay was 3.1days. From the Breast Q subscales, the mean cosmetic score was 31 out of 36 (range 27-36) (higher score reflecting better cosmetic outcome), and the mean physical well-being score was 17.25 out of 54 (range 12-29) (lower score reflecting better outcome). Overall complications were observed to be 20% which included minimal flap necrosis in 2 patients which was managed conservatively, and seromas in 2 patients which needed ultrasound-guided aspirations twice. There were no major complications. The scarless LD flap provides an adequate lower pole muscle coverage for implants in breast reconstruction. It has less morbidity and good cosmetic outcomes. It is time and cost-effective, requires no patient repositioning, and uses standard breast instruments.

A Systematic Review of the Impact of Patient Factors on BREAST-Q Outcomes After Reduction Mammoplasty.

As reduction mammoplasty rises in popularity, it will become increasingly important to understand the patient-reported outcome measurements associated with a successful operation. There has been a growing body of literature on BREAST-Q outcomes for patients undergoing reduction mammoplasty, but meta-analyses of patient factors and BREAST-Q Reduction Module scores are lacking. This study sought to ascertain which patient factors were associated with improvements in BREAST-Q scores compared with preoperative levels. A literature review through August 6, 2021, was conducted using the PubMed database to select publications using the BREAST-Q questionnaire to evaluate outcomes after reduction mammoplasty. Studies examining breast reconstruction, breast augmentation, oncoplastic reduction, or breast cancer patients were excluded. BREAST-Q data were stratified by comorbidities, age, body mass index (BMI), complication rate, and resection weight. Among 14 articles and 1816 patients, the mean age ranged from 15.8 to 55 years, mean BMI ranged from 22.5 to 32.4 kg/m2, and bilateral mean resected weight ranged from 323 to 1845.96 g. Overall complication rate was 19.9%. On average, satisfaction with breasts improved by 52.1 ± 0.9 points (P < 0.0001), psychosocial well-being improved by 43.0 ± 1.0 points (P < 0.0001), sexual well-being improved by 38.2 ± 1.2 points (P < 0.0001), and physical well-being improved by 27.9 ± 0.8 points (P < 0.0001). The mean age was positively correlated with preoperative sexual well-being (Spearman rank correlation coefficient [SRCC]: 0.61, P < 0.05). Body mass index was negatively correlated with preoperative physical well-being (SRCC: -0.78, P < 0.01) and positively correlated with postoperative satisfaction with breasts (SRCC: 0.53, P < 0.05). The mean bilateral resected weight was significantly positively correlated with postoperative satisfaction with breasts (SRCC: 0.61, P < 0.05). No significant correlations were observed between complication rate and preoperative, postoperative, or mean change in BREAST-Q scores. Reduction mammoplasty improves patient satisfaction and quality of life as reflected by the BREAST-Q. Although preoperative or postoperative BREAST-Q scores may be individually influenced by age and BMI, these variables demonstrated no statistically significant effect on the average change between these scores. This literature review suggests that reduction mammoplasty delivers high satisfaction across a diverse range of patient populations, and additional prospective cohort or comparative studies gathering robust data on other patient factors would benefit this area of research.

Long-term outcomes of breast reduction surgery: A prospective cohort study

Breast reduction surgery has been shown to be the most effective treatment for symptomatic breast hypertrophy in women. However, existing studies have been limited to a relatively short-term follow-up. This study aimed to assess the long-term outcomes following breast reduction surgery. This is a prospective cohort study of women aged 18 years and above who underwent breast reduction surgery over a 12-year period. Participants completed a series of patient-reported outcome measures, including the Short Form-36 (SF-36), BREAST-Q reduction module, Multidimensional Body-Self Relations Questionnaire (MBSRQ), and study-specific questions preoperatively, 12 months postoperatively, and at a long-term follow-up of up to 12 years postoperatively. Long-term outcome data were obtained from 103 participants. The median follow-up time following surgery was 6.0 years, range 3-12 years. The mean SF-36 scores remained stable and significantly higher than baseline over time, with no significant differences found in all eight subscales or summary scales. BREAST-Q scores remained significantly higher than baseline in all four scales. MBSRQ scores for appearance evaluation, health evaluation, and body areas satisfaction score remained significantly higher than scores reported preoperatively; in contrast, scores for appearance and health orientation and self-classified weight were significantly lower. Compared with normative data, long-term outcome scores remained stable and at levels equivalent or beyond population norms. This study demonstrated that patients continue to report a high level of satisfaction and improved health-related quality of life in the longer term following breast reduction surgery.

Long-Term Outcomes in Prepectoral versus Subpectoral Two-Stage Implant-Based Breast Reconstruction after Nipple-Sparing Mastectomy.

Implant-based breast reconstruction remains the most often used method following mastectomy, but data are lacking regarding differences in complications and long-term patient-reported outcomes for two-stage subpectoral versus prepectoral reconstruction. This study sought to better understand the risks and impact of these reconstructive approaches on overall satisfaction. Patients who underwent unilateral or bilateral nipple-sparing mastectomy and two-stage implant-based reconstruction from 2014 to 2019 were identified from the electronic medical records and contacted via email to complete the BREAST-Q survey. Overall satisfaction was measured by the question, "How happy are you with the outcome of your breast reconstruction?" using a six-point Likert scale. Patients were grouped into subpectoral or prepectoral cohorts. Complications were evaluated retrospectively. Only patients who were at least 6 months from their final reconstruction were included in the analysis. Of the 582 patients contacted, 206 (35%) responded. The subpectoral ( n = 114) and prepectoral ( n = 38) groups did not differ significantly by demographic or treatment characteristics. BREAST-Q scores were also comparable. Complication rates were similar, but prepectoral patients had a significantly higher rate of capsular contracture (16% versus 4%, P < 0.05). Bivariate ordered logistic regression identified prepectoral implant placement, having any postoperative complication, and capsular contracture as predictors of less overall happiness. The authors' study suggests that prepectoral patients may have slightly higher complication rates but are as satisfied as subpectoral patients after at least a year of follow-up. Further studies should investigate risk factors for capsular contracture, how the risk changes over time, and how the risk affects patient satisfaction.

Breast satisfaction in adult woman treated with Grisotti flap reconstruction for centrally located breast cancer, using BREAST-Q score

Breast satisfaction in adult woman treated with Grisotti flap reconstruction for centrally located breast cancer, using BREAST-Q score