Plastic Surgery Research Council

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Patient Reported Satisfaction and Quality ofLife in Predominantly Minority Obese Patients: A Comparison Between Microsurgical and Prosthetic Implant Recipients
George Kamel, MD, David Nash, MD, Robin Berk, BA, Amanda Rizzo, BA, Teresa Benacquista, MD, Evan Garfein, MD, Katie Weichman, MD.
Montefiore Medical Center, Bronx, NY, USA.

Purpose: Patients undergoing autologous breast reconstruction have higher rates of patient reported satisfaction as compared to patients undergoing prosthetic reconstruction. Obesity, defined as body mass index (BMI) >30 kg/m2, has been shown in microsurgical and implant reconstructions to increase postoperative complications making this population a great reconstructive challenge. With this challenge in mind, the purpose of this investigation was to evaluate the effects of microsurgical breast reconstruction and prosthetic breast reconstruction on patient reported outcomes and quality of life in obese patients.
Methods: After institutional review board approval was obtained, a retrospective review of patients who underwent breast reconstruction at Montefiore Medical Center from January of 2009 to December of 2015 was conducted. Patients with preoperative obesity were included for analysis.  Patients were divided into two cohorts: those undergoing microsurgical reconstruction and prosthetic reconstruction. Patients were mailed a BREAST-Q survey for response. Additionally, the demographic information, complications, and need for revisionary procedures were analyzed in comparison.  BREAST Q satisfaction was then analyzed using Q-Score software.
Results: 114 patients met the inclusion criteria: 41.2 percent (n=47) of patients underwent microsurgical breast reconstruction and 58.8 percent (n=67) underwent tissue expander/implant reconstruction. Patients in each cohort were similar in BMI, mean mastectomy specimen weight, indication for surgery, smoking status and postoperative complications. However, patients undergoing microsurgical breast reconstruction were younger (48.0 versus 53.0 years, p=0.02), more likely to have bilateral reconstruction (66.0 percent (n=31) versus 40.3 percent (n=27), p=0.007), and more likely to have delayed reconstruction (44.5 percent (n=28) versus 0.0 percent (n=0), p= 0.00001). Of those patients undergoing microsurgical reconstruction, 44.7% (n=21) responded to the BREAST-Q survey, whereas 38.8% (n=26) of patients with implant reconstruction were responders. BREAST-Q responses showed patients undergoing microsurgical breast reconstruction were more satisfied with their breasts (Q-score of 64.1 (25.3) versus 54.6 (21.0), p=0.04) and satisfaction with overall outcome (Q-score 73.5 (25.5) versus 63.5 (25.2), p=0.02). However, both cohorts had similar chest wall physical well-being, sexual well being, and psychosocial well being.
Conclusions: Microsurgical breast reconstruction in obese patients yields higher satisfaction with breasts and overall outcomes as compared to implant based reconstruction. Despite increased postoperative complications associated with obese patients, microsurgical breast reconstruction appears to offer a superior reconstructive choice. This information will be important in preoperative patient discussions and counseling.
Scale (range, 0-100)No CompletingMean Q- ScoreSDMean Score DifferenceP value
Satisfaction with Breasts
Microsurgical
Prosthetic
21
26
64.1
54.6
25.3
21.0
9.50.04
Satisfaction with Outcome
Microsurgical
Prosthetic
21
26
73.5
63.5
25.5
25.2
10.00.03
Psychosocial well-being
Microsurgical
Prosthetic
21
26
71.7
68.3
26.0
23.5
3.40.63
Sexual well-being
Microsurgical Prosthetic
21
26
54.5
50.20
26.2
29.5
4.30.61
Physical well-being chest
Microsurgical
Prosthetic
21
26
66.6
62.9
14.3
20.0
3.70.48


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