|Program and Abstracts
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Does Time Affect Patient Satisfaction?
Wess A. Cohen, MD, Nima P. Patel, MD.
Maimonides Medical Center, Brooklyn, NY, USA.
In an effort to provide patient centered care, surgeons should properly inform patients of the expected post-operative course. A total of 62,611 patients with breast hypertrophy underwent breast reduction surgery in 2013 in the United States to improve their symptoms and quality of life (QOL). While multiple studies utilizing various outcomes instruments demonstrate the efficacy of reductive surgery, only four have utilized the BREAST-Q: a validated questionnaire and the current standard for procedure specific patient reported outcomes (PROs). Additionally, it is presently unknown how the postoperative course affects patient’s symptoms, satisfaction, and QOL. Given this, the objective of the study was to determine the temporal relationship of patient satisfaction and health related-quality of life (HR-QOL) after reduction mammoplasty. By identifying this association, surgeons will be better able to assist patients in managing their postoperative expectations.
Patients anonymously completed the BREAST-Q reduction/mammoplasty module preoperatively, at less than 3 months postoperatively, and at more than 3 months (less than 12months) postoperatively. A single surgeon performed all of the breast reduction procedures.
19 preoperative patients and 40 postoperative patients (20 at less than 3months, and 20 at more than 3 months) completed the BREAST-Q. Preoperative mean q-scores for satisfaction with breasts, psychosocial, sexual, and physical well-being significantly increased across all variables when compared to either post-operative time point. There was no significant difference, however, in satisfaction or HR-QOL when comparing the postoperative time points to one another. See table 1.
While clinical experience can assist physicians in anticipating clinical outcomes and changes over time, PROs provide a direct measure of patients’ satisfaction and HR-QOL. By evaluating patients for up to 1 year post-operatively, the study provides clinicians with the likely evolution of patients’ satisfaction and QOL during the period over which they will have the most interactions with their patients.
In our study, we show that reduction mammoplasty provides sustained patient satisfaction and HR-QOL and does not suffer from declining PRO as is seen in breast reconstructive surgery after mastectomy. Patients and physicians alike should be confident that the outcome following surgery will mirror that seen at up to 1 year postoperatively and will likely be positive from a patient’s perspective. This affords surgeons the opportunity to better inform their patients that if the patient is at all dissatisfied after the operation, that the results are unlikely to improve and a revision may be necessary. Alternatively, this fact should also provide surgeons with confidence that their patients will likely remain pleased with the surgical outcome in the immediate postoperative period as well as in the long term. By removing unwanted and unnecessary breast mass, plastic surgeons have the ability to not only improve the aesthetic appearance of the breasts and to reduce physical symptoms, but they also increase patients’ psychosocial well-being while enhancing their sexual confidence for a sustained period of time.
Table 1. BREAST-Q Q-scores
|Satisfaction with Breasts|
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