Choice of Breast Reconstruction After Mastectomy Affects Satisfaction, Quality of Life

Breast reconstruction is now the choice of more than 60% of breast cancer survivors who have undergone mastectomy, marking an increase of approximately 20% since 1998. A number of explanations exists for this: advances in genetic testing and imaging, continually improving reconstructive techniques, and increased media attention on celebrity patients. Recently, prominent and respected women have described their breast cancer risks, illnesses, and treatments in great detail, explaining their choices of therapeutic and/or prophylactic mastectomy and reconstruction.¹

Perhaps the most significant reason for the increasing popularity of breast reconstruction is that it can lead to a better quality of life for the patient, which is essential for relieving her postmastectomy psychological distress. Therefore, a group of 57 North American plastic surgeons sought to determine which has a greater influence on the survivor’s quality of life (QOL): that she has undergone breast reconstruction per se or the type of reconstruction procedure performed.

The Mastectomy Reconstruction Outcomes Consortium study is a multicenter study designed to measure whether breast reconstruction with an implant or an autologous procedure makes a difference in the survivor’s outlook. Eligibility criteria included age 18 years or older and undergoing first-time immediate unilateral or bilateral reconstruction for cancer treatment or prophylaxis. The prospective trial ran from February 2012 through July 2015 and comprised 2013 patients (1490 underwent implant reconstruction, 523 underwent autologous tissue reconstruction). Mean age was 48 years in the implant group and 52 years in the autologous reconstruction group. All patients were followed for a minimum of 2 years.

The techniques considered in this evaluation were breast reconstruction after mastectomy for cancer treatment or prophylaxis via immediate implant-based reconstruction (direct-to-implant or tissue expander and implant) or autologous reconstruction (pedicled transverse rectus abdominis myocutaneous flap, free transverse rectus abdominis myocutaneous flap, deep inferior epigastric perforator flap, or superficial inferior epigastric artery flap).

Although type of procedure — implant vs autologous — was the primary criteria, other demographic variables considered were age, race, ethnicity, body mass index, level of education, income, marital status, employment, diabetes and/or smoking status; other clinical variables included indication for mastectomy, type of procedure including whether unilateral or bilateral, adjuvant therapy (radiotherapy and/or chemotherapy), and lymph node management.