BREAST-Q Survey Research Articles

Abstract PO4-11-12: Patient Reported Outcomes from a multi-site, prospective Pivotal study evaluating pegulicianine fluorescence guided surgery (pFGS) for breast cancer lumpectomy procedures using the Lumicell Direct Visualization System (DVS)

Abstract Background: In pegulicianine fluorescence guided surgery (pFGS), a standard of care lumpectomy procedure is performed, and additional tissue is taken from cavity walls at sites of high pFGS signal. This approach been shown to reduce 2nd surgeries and remove additional tumor left by standard surgery, but may remove more tissue, potentially worsening cosmetic outcomes. Patient breast satisfaction surveys were used to assess cosmesis after pFGS. Methods: A prospective Pivotal trial of pFGS in women undergoing lumpectomy surgery for stage 0-III breast cancer was conducted at 14 US sites (NCT03686215). We assessed the safety and efficacy of the Lumicell DVS in identifying and removing residual cancer from the lumpectomy cavity in real time. Patient Reported Outcome Measures (PROM) data was collected as an exploratory endpoint. The BREAST-Q, a validated tool that measures patient perspectives after different breast procedures, was used to collect PROM data. An 11-question BREAST-Q survey was used to measure patients’ breast satisfaction at baseline (pre-surgery) and at multiple timepoints through 6-months post lumpectomy. Descriptive statistics of participating patients’ responses were collected and analyzed. Survey results were analyzed by the distribution of patient ratings for each question and the change in the distribution of ratings over time, with comparison of baseline to post-lumpectomy. Comparison of patient satisfaction with or without additional pFGS-directed tissue removal was performed with Item Response Theory assuming all items equally discriminative of responding patients. For each timeframe, responses to BREAST-Q items were used to create a response score for each patient. Scaled factor scores (0-100) were compared between groups with and without additional tissue removed during pFGS. Results: Of the 357 patients evaluated for efficacy in the primary Pivotal study analysis, 255 patients agreed to participate in the PROM surveys (71%). Approximately 60% of the participating respondents completed a pre- and initial post-lumpectomy survey while only 34% of the participating patients completed a pre- and 6-month post-lumpectomy survey. Most patients responded either “Very Satisfied” or “Somewhat Satisfied” across all surveyed timeframes. No significant difference in patient breast satisfaction was found at any time point between the groups with and without additional pFGS-guided shaves removed (p >0.05). There were 4 patients with scores of 3 or higher pre-surgery but 2 or lower post-surgery. Among these, 1 had no pFGS-guided shaves taken. The remaining 3 had had pFGS-guided shaves taken, but 2 required a second lumpectomy surgery and 1 underwent mastectomy, these additional surgeries likely accounting for decreased cosmetic outcomes. Discussion: Patient perspective of breast satisfaction was not decreased by the amount of extra tissue removed by pFGS. These data suggest that pFGS using the Lumicell DVS does not significantly decrease breast cosmesis. Three of 4 patients with decreased satisfaction had 2nd surgeries, confirming the importance of finding approaches to decrease 2nd surgeries. This data was collected during the COVID-19 pandemic, which may have adversely impacted the compliance rate of survey completion. Studies in larger cohorts with longer follow up are required to better assess the relative impact of 2nd surgeries, radiation, and systemic therapy on breast satisfaction PROM scores after lumpectomy. Citation Format: Kelly Hunt, Irene Wapnir, E Shelley Hwang, David Carr, Peter Blumencranz, Kate Smith, Manna Chang, Jorge Ferrer, Barbara Smith. Patient Reported Outcomes from a multi-site, prospective Pivotal study evaluating pegulicianine fluorescence guided surgery (pFGS) for breast cancer lumpectomy procedures using the Lumicell Direct Visualization System (DVS) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-11-12.

Patient Satisfaction Using BREAST-Q and Breast Implant Illness after Breast Reconstruction in Transwomen.

Gender-affirming breast augmentation comprises an increasing portion of breast augmentations performed by plastic surgeons. Satisfaction and breast implant illness (BII) symptoms in this population have not been well studied. This study aimed to evaluate satisfaction and BII symptoms in transwomen who received nontextured implants as part of their breast reconstruction. We conducted a retrospective review of transwomen who underwent breast augmentation for gender-affirming surgery. We performed telephone survey evaluation using the BREAST-Q questionnaire preoperatively, 6 months and 1 year after breast implant placement. Survey evaluation asking about BII symptoms was also administered at the same time points. Twenty-six patients completed the BREAST-Q survey, which demonstrated significantly improved satisfaction postoperatively at 6 and 12 months when compared with median preoperative scores for psychosocial (P < 0.001; P < 0.001), sexual (P < 0.001; P < 0.001), and overall satisfaction with breasts (P < 0.001; P < 0.001). Physical well-being of the chest decreased at 6 months (P < 0.001) but improved in comparison with 12 months (P < 0.001). Thirty-four patients completed the BII survey, with 18% reporting symptoms at 3 months and 29% at 1 year. Zero patients requested explantation. Transwomen exhibit a significant increase in breast, psychosocial, and sexual well-being after breast augmentation. However, patients experienced a decreased physical well-being, and many report symptoms associated with BII. These results can be used to better counsel these individuals preoperatively and set reasonable postoperative expectations. Further studies investigating long-term satisfaction in larger cohorts are needed.

Patient-reported outcomes of nipple reconstruction with a composite graft from the contralateral nipple

Background Local flap techniques are commonly employed for nipple reconstruction. This study was conducted to present the surgical outcomes of composite nipple grafts performed in patients for whom local flap techniques were not suitable.Methods This study included 26 patients who underwent composite nipple grafting between February 2014 and March 2021. Data regarding demographics and complications were obtained through retrospective chart review. Complications, including wound dehiscence and total or partial necrosis, were evaluated by the surgeon. The BREAST-Q survey (as described by Spear et al.) was utilized to investigate patient satisfaction with the reconstructed nipple as well as donor-site morbidity.Results No instances of wound dehiscence, infection, implant exposure, or total necrosis were noted. However, partial necrosis was observed in five patients (19.2%) and healed well with local wound care. The odds ratio (OR) for partial necrosis was not significantly higher in patients who received radiotherapy than in those who did not (OR=1.06, P=0.97). The color and projection of the reconstructed nipple were generally found to be satisfactory. Regarding donor-site morbidity, sensation and contractility were well preserved.Conclusions This study demonstrated that composite nipple grafting is a viable option, as it reduces the size of the relatively large nipple on the normal side while preserving nipple sensation and contractility. This technique can be applied using a thin skin flap that covers the prosthesis following irradiation or a tissue expansion procedure, with minimal risk of compromising the nipple.

977 The Impact of Post-Mastectomy Radiotherapy on Immediate Free Flap Breast Reconstruction

Abstract Aim Radiotherapy following free flap breast reconstruction has historically been thought to increase complication rates, worsen patient reported outcomes (PROs) and lead to poorer cosmetic results. We aim to assess the impact post-mastectomy radiotherapy (PMRT) has on immediate free flap breast reconstruction using these variables, with patients acting as inherent controls. Method We conducted a retrospective cohort study on all patients receiving immediate bilateral free flap breast reconstruction followed by unilateral radiotherapy between 2008 and 2022. Complication rates were assessed by comparing prevalence of fat necrosis, volume depletion requiring lipofilling, and flap loss among irradiated vs non-irradiated breasts. PROs were assessed by comparing “Satisfaction with Breasts” and “Chest Physical Well-Being” (two sections of the Breast-Q survey) among irradiated vs non-irradiated breasts. Cosmetic outcomes were assessed by scoring postoperative pre-radiotherapy and postoperative post-radiotherapy patient images using “Objective Breast Cosmesis Scale” (OBCS) and “Harvard Breast Cosmesis Scale” (HBCS). Results 9 patients underwent immediate bilateral free flap breast reconstruction followed by unilateral radiotherapy. Median age was 40 years (IQR 32-44). Complication rates did not vary significantly between irradiated and non-radiated breasts. “Satisfaction with Breasts” did not vary significantly between irradiated and non-radiated breasts; however, “Chest Physical Well-Being” did vary significantly between both breasts. Cosmetic outcomes did not vary significantly between pre-radiotherapy and post-radiotherapy images. Conclusions PMRT following immediate free flap breast reconstruction does not have significant deleterious effects on complication rates, patient satisfaction with breasts or cosmetic outcomes. However, radiotherapy has a significant effect on patient’s chest physical well-being, hence we aim to study this further.

1276 The Impact of Low BMI on Patient Reported Satisfaction Following Deep Inferior Epigastric Perforators Flap Breast Reconstruction in a National Breast Cancer Centre in the Republic of Ireland

Abstract Introduction Low-BMI patients are candidates for both implant and free autologous tissue breast reconstruction. However, deep inferior epigastric perforators (DIEP) flaps are not a popular option among thin women. The objective of this study was to evaluate patient reported outcomes among this patient’s population. Method A retrospective chart review was conducted for all the DIEP-based reconstruction performed over a five-year period between June 2016 and June 2021. Inclusion criteria included patients with BMI &amp;lt; = 25. Data collection included patients’ demographics, timing of surgery, laterality, number of pedicles, irradiation, complications and adjustments thereafter. After Ethical approval, patients were contacted to assess post-operative satisfaction using the Breast-Q ®. Results During the study period, 169 DIEP flap-based reconstruction were performed, a total of 59 patients fell in the low BMI category. Twenty-seven patients had immediate reconstruction and only 2 patients had bi-pedicled flap. The Average age was 48.8 years and average was BMI 23.3. The majority of our patients were non-smoker (n = 57) and didn’t receive adjuvant radiation (n = 43). Only 32.6% (n = 15) had adjustment. The unilateral reconstruction patients made 93.0% (n = 14) of those requiring adjustment with 60% of them (n = 9) undergoing lipofilling. The total response rate to the Breast-Q survey was 79.6% (n = 47). Overall Breast-Q scores showed high satisfaction with breasts with high overall levels of psychological, sexual, and physical wellbeing. Conclusions DIEP flap-based reconstruction was demonstrated to be a safe and aesthetic reliable procedure in our cohort, yielding high level of psychological, sexual and physical wellbeing.

Long-Term Patient-Reported Outcomes Comparing Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery: A Propensity Score-Matched Analysis.

Oncoplastic breast surgery (OBS) combines plastic surgery techniques with conventional breast-conserving surgery (BCS) and expands BCS eligibility. Limited data are available on patient-reported outcomes (PROs) after OBS. Here we compare long-term PROs after OBS and BCS utilizing the BREAST-Q. Women undergoing OBS or BCS between 2006 and 2019 who completed ≥ 1 long-term BREAST-Q survey 3-5 years postoperatively were identified. Baseline characteristics were compared between women who underwent OBS/BCS. Women who underwent OBS were paired with those who underwent BCS using 1:2 propensity matching [by age, body mass index (BMI), race, T stage, and multifocality]. BREAST-Q scores were compared preoperatively and 3-5 years postoperatively. A total of 297 patients were included for analysis (99 OBS/198 BCS). Women who underwent OBS were younger (p < 0.001) and had higher BMI (p = 0.005) and multifocal disease incidence (p = 0.004). There was no difference between groups in nodal stage, re-excision rates, axillary surgery, chemotherapy, endocrine therapy, or radiotherapy. After propensity matching preoperatively, women who underwent OBS reported lower psychosocial well-being (63 versus 100, p = 0.039) but similar breast satisfaction and sexual well-being compared with women who underwent BCS; however, only three patients who underwent BCS had preoperative BREAST-Q scores available for review. In long-term follow-up, women who underwent OBS reported lower psychosocial scores (74 versus 93, p = 0.011) 4 years postoperatively, but not at 5 years (76 versus 77, p = 0.83). There was no difference in long-term breast satisfaction or sexual well-being. Women who undergo OBS present with a larger disease burden and may represent a group of non-traditional BCS candidates; they reported similar long-term breast satisfaction and sexual well-being compared with women who undergo BCS. While women who underwent OBS reported lower psychosocial well-being scores preoperatively and during a portion of the follow-up period, this difference was no longer seen at 5 years postoperatively.

Systematic Review of Patient-Reported Outcomes and Complications of Pedicled Latissimus Flap Breast Reconstruction.

The latissimus dorsi (LD) flap is a reliable option for breast reconstruction. This is particularly true in patients with contraindications to abdominally based autologous breast reconstruction. A systematic review of patient satisfaction and health related quality of life following LD breast reconstruction using the BREAST-Q survey was conducted. The scope of the review was to determine the degree of patient satisfaction following the procedure and to examine how patient satisfaction from the pedicled LD flap compares to other breast reconstructive procedures. A literature search on BREAST-Q in LD flap reconstruction was performed. Only articles written in English and in published peer-reviewed journals were included. Studies with less than 20 patients in their sample and those with a follow-up period of less than 1 year were excluded. Five articles representing 331 patients were reviewed, including one case-control study and four retrospective cohort studies. Level of evidence was either III (4) or IV (1). The average age was 53 with average body mass index of 25. Most reconstructions were delayed (67%) and unilateral (88%), and most patients required radiation (79%). The average length of follow-up was 36 months, and the response rate was 75%. Overall, patients who underwent LD flap reconstruction reported favorable outcomes in satisfaction domains and quality of life domains with few complications. A meta-analysis also demonstrated higher satisfaction in LD flap without implants compared with LD flap with implants. Patient-reported outcomes following LD breast reconstruction compare favorably with other techniques of breast reconstruction.

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.

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.

Defining the Standard for DIEP Donor Site Outcomes: A Decade Long Study on Microvascular Breast Reconstruction and BREAST-Q Patient Satisfaction

Introduction: Previous studies have reported on abdominal donor site complications after DIEP breast reconstruction with a lack of standardization. The aim of this study is to be able to standardize reporting of abdominal donor site complications as well as include patient-reported outcomes based on these standards. Materials and Methods: This retrospective study was conducted on patients who underwent any type of DIEP flap breast reconstruction performed at an academic institution between January 2011 – December 2021. Patients were excluded if they had a history of breast reconstruction or abdominal surgeries, post-reconstruction radiation, or if underwent a concomitant autologous flap reconstruction. Primary outcomes of this study included abdominal donor site complications, treatment outcomes, and BREAST-Q survey responses. Results: 502 patients were evaluated in this study. Our complication rate was 35.3% of the study population, with minor complications making up 68.1% (n = 205) and major making up 31.9% (n = 96) of complications. A moderately strong association was noted between history of DVT/PE and major complications, φ = 0.174, p < 0.001. An association that was reaching significance was noted between umbilical preservation and minor complications, φ = 0.086, p = 0.055. In our logistic regression BMI, hypertension, and umbilical preservation were associated for increased association of minor complications, while BMI, race, hypertension, and history of DVT/PE were associated for increased risk of major complications. Patient cohort reported higher postoperative psychosocial well-being in minor complications (80.49, EMM) while higher postoperative physical well-being: abdomen in no complications (73.50, EMM). Conclusion: This is the first study of its kind discussing the topic of standardizing abdominal donor site complications after DIEP breast reconstruction. This form of classification can be used to dictate treatment options of patients as well as improve on factors that can reduce post-operative complications.

Short-term Satisfaction, Psychosocial Impact, and Complication Profile of Reduction Mammaplasty during Adolescence.

Reduction mammaplasty is an effective and safe treatment option for adults with symptomatic macromastia, but there is less data regarding outcomes in adolescents. The purpose of this study is to determine the short-term psychosocial impact, satisfaction, and safety of reduction mammaplasty when performed during adolescence. A retrospective review was performed of a single pediatric plastic surgeon's experience with reduction mammaplasty from 2018 to 2021 in patients ≤ 18. Patients completed the preoperative and postoperative "Satisfaction with Breasts" and "Psychosocial Well-Being" sections of the BREAST-Q Survey. Clinical variables gathered included age, weight, BMI, complication profile, specimen resection weight, and follow-up duration. 41 patients met inclusion criteria. The mean converted Rasch scores for BREAST-Q "Satisfaction with Breasts" and "Psychosocial Well-Being" increased significantly following reduction mammaplasty (Satisfaction with Breasts, Preop: 24.1 vs. Postop: 92.6; Psychosocial Well-Being, Preop: 37.7 vs. Postop: 90.4, p < 0.001). Obesity (BMI ≥ 30 kg/m2) was associated with lower preoperative "Psychosocial Well-Being" scores (Obese: 29.7 vs. Non-obese: 43.3, p < 0.001) but a greater improvement in score following surgery (Obese: + 63.9 vs. Non-obese: + 44.9, p < 0.001). Specimen weight ≥ 1,000 grams was also associated with greater improvement in score on the "Psychosocial Well-Being" section (≥ 1,000 grams: + 58 vs. < 1,000 grams: + 49.7, p = 0.046). Overall complication rate was 31.7% while the major complication rate was 2.4%. Mean specimen resection weight was higher in patients who experienced complications (1141.3 grams vs. 836.8 grams, p = .008). Reduction mammaplasty during adolescence predictably improves both short-term satisfaction with breasts and psychosocial well-being while demonstrating a favorable short-term complication profile.

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.

Access to Results of Patient Reported Outcome Surveys Does Not Improve Survey Response Rates

IntroductionIn this embedded substudy of a longitudinal, randomized controlled trial, we sought to evaluate the effects of patient engagement and results feedback on longitudinal patient-reported outcome (PRO) survey completion rates. MethodsNewly diagnosed stage 0-III breast cancer patients seen at an academic breast center between June 2019 and December 2021 were invited to participate in a longitudinal PRO study. Participants were emailed the BREAST-Q survey, a validated PRO scale, preoperatively and at regular intervals during their postoperative course. Patients were randomized into the intervention group, who received survey results upon completion, or the control group, who received no feedback. The primary endpoint was postoperative survey completion rate. An intention to treat analysis was performed and a quasi-Poisson regression was used to compare rates of longitudinal survey completion between the two groups. ResultsOf the 253 patients offered the preoperative survey, 115 were in the intervention group and 138 were in the control group. Postoperative survey completion rate was 54% for the intervention group and 47% for the control group. There was no significant difference in longitudinal postoperative survey completion rate between the two groups (rate ratio 1.10; 95% confidence interval [CI] 0.93-1.31). ConclusionsIn this prospective randomized controlled study, patients did not complete surveys at a higher rate when their survey results were shared with them, suggesting that viewing these results without appropriate clinical context does not generate significant enhancement in patient engagement. Effective interventions to improve survey response rate must be identified to better evaluate PROs.

A single centre experience of local perforator flaps in oncoplastic breast surgery; a cross-sectional study.

Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fasciocutaneous pedicled chest wall perforator flaps or local perforator flaps (LPF). The objectives of this study were to document the details of the surgical procedure as well as patient-reported satisfaction and well-being following the procedure using a validated BREAST-Q tool among Pakistani women. This cross-sectional study was conducted from March 2019 to February 2021 enrolling 25 female patients who underwent breast conservative surgery using LPF for breast tumors at The Aga Khan University Hospital, Karachi. Data related to the procedure was collected on a pre-designed proforma. Cosmetic outcomes and patient satisfaction were evaluated using 2 scales from BREAST-Q BCT domain version 2.0. The questionnaire was self-administered by the patients during their routine follow-up in the clinic. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Mean (SD)/median (IQR) were computed for quantitative variables and frequency and percentages were calculated for qualitative variables. 2 sample t-test was applied. P-value ≤0.05 was considered significant. 25 patients underwent LPF with a mean age of 47±13.1 years. 8 LICAP, 7 AICAP, and 10 LTAP flaps were performed. Two postoperative complications of wound site erythema were encountered. 23 women were eligible for the BREAST-Q survey. Median (IQR) postoperative satisfaction with breasts and physical well-being chest (equivalent Rasch transformed score) was 100 (41) and 76 [18] respectively. We found high satisfaction with breasts and comparable physical well-being among Pakistani women after LPF surgeries. Local perforator flaps in oncoplastic breast-conserving surgery are a good option showing high satisfaction with breasts and physical well-being in Pakistani women.

Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction

Aim of this study is to compare early post-operative outcomes and patient’s satisfaction after skin-sparing and/or nipple-sparing mastectomy (SSM/SNSM) followed either by breast reconstruction with one-stage prepectoral implantation or two-stage technique for breast cancer (BC) or BRCA1/2 mutation.From January 2018 to December 2021, 96 patients (mean age of 51.12 ± 10.9) underwent SSM/SNSM and were divided into two groups: in group A (65 patients, 67.7%), mastectomy was followed by one-stage reconstruction; in group B (31 patients, 32.3%) by two-stage. Operative time was significantly longer in A vs. B (307.6 ± 95.7 vs. 254.4 ± 90.91; P < 0.05). Previous breast surgery was more common in B vs. A (29.0% vs. 7.7%; P < 0.05), while bilateral surgery was performed more frequently in A vs. B (40% vs. 6.5%; P = 0.001). All SSM/SNSM for BRCA1/2 mutation were followed by immediate prepectoral implantation. No significant differences were found between groups in terms of post-operative complications. At pathology, DCIS and invasive ST forms, such as multicentric/multifocal forms, were detected more frequently in B, while NST type in A (all P < 0.05). A multivariate analysis showed improved post-operative satisfaction at BREAST-Q survey in Group A (P = 0.001). Encouraging oncologic outcomes after SSM/SNSM for BC enabled the improvement of breast reconstructive techniques. One-stage reconstruction is characterized by better aesthetic outcomes and by greater patient’s satisfaction. When SSM/SNSM is technically difficult to perform, as in multicentric/multifocal forms or previous breast surgery, mastectomy followed by two-stage reconstruction should be considered to achieve a radical surgery.

Flap to Mastectomy Mass: Are Higher Ratios Associated with Greater Breast Reconstruction Satisfaction?

Autologous breast reconstruction is associated with superior patient-reported outcomes compared with prosthetic techniques, but little is known about the relationship between autologous flap mass and patient satisfaction. We hypothesized that a higher differential mass (ratio of flap mass to mastectomy mass) would be associated with greater satisfaction with reconstruction. In this retrospective study, patients who underwent autologous breast reconstruction between 2015 and 2020 with a deep inferior epigastric perforator (DIEP) flap completed the BREAST-Q survey. Multivariate linear regression models were used to examine the relationship between differential mass and patient satisfaction. Models controlled for body mass index (BMI), age at surgery, reconstruction size preference, number of surgeries, previous surgery failure, whether the patient underwent radiation therapy, and whether reconstruction was unilateral or bilateral. Overall, 45 patients (70 breasts) completed the BREAST-Q survey. Mean age at reconstruction was 52.2 years and mean time to survey completion following surgery was 21.1 months. Most patients (59.4%) desired a smaller breast after reconstruction. The mean differential mass was +26.3% (flap mass greater than mastectomy mass). Differential mass was positively associated with all satisfaction measures with results being significant for satisfaction with breasts scores (p=0.032). In this preliminary study, a higher ratio of autologous flap mass to mastectomy mass was associated with overall higher patient-reported satisfaction. A 1:1 flap to mastectomy mass ratio may not adequately reapproximate desired breast size or shape. Larger autologous flap mass may be favorable for long-term patient satisfaction, and future studies should investigate the relationship between differential mass and breast esthetics.

Sexual Well-Being After Nipple-Sparing Mastectomy: Does Preservation of the Nipple Matter?

The primary aim of this study was to evaluate patient-reported outcome measures in patients undergoing mastectomy with and without breast reconstruction (immediate or delayed) with and without nipple preservation. All female patients undergoing mastectomy between 2011 and 2015 at Mayo Clinic Rochester were identified and were mailed the BREAST-Q survey. Breast satisfaction, psychosocial well-being, and sexual well-being were evaluated and compared by surgery type using Wilcoxon rank-sum tests for univariate analysis and linear regression for multivariable analysis adjusting for potential confounders. Of 1547 patients, 771 completed the BREAST-Q survey (response rate 50%). Of these 771 respondents, 237 (31%) did not have reconstruction, 198 (26%) had nipple-sparing mastectomy with reconstruction (NSM), and 336 (44%) had skin-sparing mastectomy with reconstruction (SSM) ± nipple-areolar complex (NAC) reconstruction (via surgery±tattoo). Patients with breast reconstruction had consistently higher BREAST-Q scores versus those without. Comparing NSM with all SSMs, there was no difference in satisfaction with breasts (mean 71.8 vs. 70.2, p=0.21) or psychosocial well-being (mean 81.9 vs. 81.3, p=0.47); however, sexual well-being was significantly higher in the NSM group on univariate (mean 64.5 vs. 58.0, p=0.002) and multivariable (β=-4.69, p=0.03) analysis. Sexual well-being scores were similar for NSM and the SSM subgroups with any type of NAC reconstruction. This study demonstrates that NSM positively impacts patient sexual well-being after breast reconstruction compared with SSM, particularly SSM without nipple reconstruction or tattoo. SSM with any type of NAC reconstruction achieved similar satisfaction and sexual well-being to those undergoing NSM.

P60. PATIENT FACTORS THAT AFFECT PRE-OPERATIVE PATIENT REPORTED OUTCOMES IN WOMEN UNDERGOING BREAST CANCER SURGERY

PURPOSE: Understanding the impact of patient, disease, and treatment factors on pre-operative patient reported outcomes (PROs) is important to guide surgical decision-making with breast cancer. METHODS: This prospective cohort study evaluates PROs in women undergoing breast cancer treatment at a metropolitan health care system. New cases undergo tumor board discussion and same-day consultations with various specialties. Women choose to complete pre- and post-operative Breast-Q© Breast Conserving Surgery(BCS), Mastectomy(M), or Reconstruction(R) modules and demographic surveys. Individual associations to pre-operative Breast-Q survey scores were assessed using linear regression models (one for each Breast-Q survey type). Variables significant for at least one survey were included in multiple linear regression models. RESULTS: 375 women completed the pre-operative surveys (BCS=244, M=39, BR=92). Procedure choice, laterality, race, marital status, employment, prior breast cancer, neoadjuvant chemotherapy, or history of radiation or chemotherapy did not impact PROs. Breast satisfaction decreased with higher BMI (est=-0.367, p=0.045) and stage 2 disease (est=-11.011 (vs. stage 0), p=0.008). Lower psychosocial score was associated with younger age (est=0.271, p=0.002), higher BMI (est=-0.367, p=0.014), and income <35k (est=0.172 (vs. 35k+), p=0.016). Similarly, lower physical well-being of the chest was associated with younger age (est=0.207, p=0.011), higher BMI (est=-0.285, p=0.039), and income <35k (est=0.218 (vs. 35k+, p=0.039). Sexual well-being decreased with higher BMI (est=-0.545, p=0.004) and income <35k (est=0.135 (vs. 35k+), p=0.016). CONCLUSION: While factors such as age, BMI, and stage of disease are difficult to change prior to surgery, patients with lower income may need special interventions to assist them through the treatment process.

260 Comparison of Patient Satisfaction and Outcomes of Day Case Mastectomy Versus Inpatient Model, Using a Validated Questionnaire

IntroductionMany women undergoing simple mastectomy have an overnight hospital stay. Offering a day case procedure for simple mastectomy has the potential to improve outcomes in terms of patient safety, feasibility, and reduction in associated costs. We aimed to study the proportion of day case mastectomies over a 2-year period and assessed relative readmission and complication rates alongside patient reported outcome measures (PROMs). Following this, we wanted to analyse whether a day case procedure should be routinely offered.MethodA retrospective audit was conducted on all patients undergoing a simple mastectomy. Data were collected from patient and pathology records. PROMs were obtained via telephone conversation using the validated BREAST-Q survey. Patient demographics, reason for mastectomy and readmission for complications were all assessed.ResultsOut of the 202 patients analysed, over 75% had an overnight stay. The most common complications for both groups of patients were readmission due to infection and haematoma evacuation, with similar rates across the two (p = 0.26, p = 0.69). Data from PROMs also suggested that patients had similar outcome and satisfaction levels (p = 0.27).ConclusionsThe result from this study shows that it is safe as well as acceptable to patients to offer simple mastectomies as a day case procedure. This has become more important since COVID-19 reduced inpatient theatre capacity, and it is anticipated that these outcomes will allow a routine day case mastectomy pathway to be established even when normal operations recommence as encouraged by the association of day case surgery.

Nipple-Sparing Mastectomy: Initial Experience Evaluating Patients Satisfaction and Oncological Safety in a Tertiary Care Centre in Jordan.

IntroductionNipple-sparing mastectomy (NSM), a procedure involving careful dissection of the breast tissue whilst keeping the nipple-areola complex (NAC) intact, is now increasingly practiced amongst surgeons in the treatment of certain situations of breast cancer. Given the importance of breasts to the female body image, this type of conservative breast surgery takes into account patient satisfaction and overall cosmesis, whilst ensuring appropriate oncological safety.Methods and resultsFour nipple-sparing mastectomy procedures were performed in our tertiary care centre, Princess Basma Teaching Hospital, in Jordan between June and September 2019. Indications for these procedures included invasive ductal carcinoma, malignant phyllodes, and high-grade ductal carcinoma in-situ. Patients were carefully assessed prior to surgical intervention using radiological imaging, ensuring a distance from NAC of >2 cm in all cases. Procedures were performed successfully with minimal intraoperative and no post-operative complications. Follow-up was carried out at 24 months, with no cases of local or distant post-operative recurrence, and patient satisfaction was qualitatively measured with the use of a BREAST-Q questionnaire. The questionnaire demonstrated improved overall physical well-being and satisfaction with an average overall post-operative physical well-being of 97%.ConclusionFollowing nipple-sparing mastectomy and immediate submuscular reconstruction with silicone implants,patients demonstrated high levels of satisfaction and quality of life (QoL) as measured by BREAST-Q survey. Two years of follow-up confirmed high patient satisfaction with increased scores from the preoperative baseline level.