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Resume Sujet Le syndrome de sein tubereux (ST) est une malformation complexe du sein pouvant toucher la forme, le volume et la symetrie des seins. Il est a l’origine d’une souffrance physique et psychique avec un impact sur la qualite de vie. L’objectif de notre etude etait d’evaluer le resultat a long terme de la chirurgie des ST ainsi que la satisfaction et la qualite de vie des patientes operees. Materiel et methodes Toutes les patientes ayant beneficie d’une chirurgie primaire pour ST entre janvier 2007 et decembre 2018 ont ete retrospectivement identifiees, celles operees par implants et/ou mammoplastie de reduction ont ete incluses. L’âge, le grade de la malformation, la symetrie mammaire, l’IMC, les grossesses, l’allaitement, le type de chirurgie initiale, les complications et le nombre de reinterventions ont ete recueillis. La satisfaction postoperatoire au long terme etait evaluee a l’aide du questionnaire BREAST-Q (module augmentation ou reduction selon la chirurgie initiale). Resultats Quatre-vingt-deux patientes ont ete recrutees dont 35 operees de protheses bilaterales, 14 de protheses unilaterales avec ou sans mammoplastie controlaterale et 33 de mammoplastie de reduction. Le suivi moyen etait de 7,4 ans tous groupes confondus. Le nombre de reinterventions etait significativement plus eleve pour les patientes operees par protheses (p = 0,001) et pour les patientes ayant un grade severe de la pathologie (p = 0,01). Quarante patientes ont repondu au questionnaire BREAST-Q. Les scores de satisfaction des patientes des differents groupes n’etaient pas significativement differents. Concernant les scores de qualite de vie, les patientes operees par protheses bilaterales semblaient avoir un meilleur score concernant l’item « sexual well being » (p = 0,03). Le score « physical well being » etait moins bon pour les patientes operees de mammoplastie de reduction par rapport aux autres groupes (p = 0,01). Les patientes porteuses de protheses avaient une qualite de vie significativement meilleure pour les items « psychosocial well being » (p = 0,02), « sexual well being » (p Conclusions Les patientes operees de ST sont globalement satisfaites a long terme. Le nombre de reinterventions ne semble pas influencer la satisfaction des resultats.

Resume Introduction La reconstruction mammaire par implant presente des inconvenients a long terme et conduit un nombre croissant de patientes a demander une chirurgie secondaire de correction. Deux strategies chirurgicales sont possibles : le changement d’implant (associe a des gestes de capsulectomie/capsulotomie et/ou lipofilling) et le retrait d’implant associe a l’apport d’un tissu autologue (lambeau et/ou lipofilling). Methode Entre 2010 et 2018, 54 patientes ont beneficie d’une chirurgie secondaire de correction d’une premiere reconstruction mammaire par implant. Les motifs d’insatisfaction de la reconstruction initiale, les interventions realisees et les complications postoperatoires ont ete analyses. Le bien-etre et la satisfaction des patientes ont ete evalues au moyen du questionnaire BREAST-Q. Resultats Trente-quatre patientes ont beneficie d’un changement de prothese et 20 patientes d’un retrait definitif de leur prothese associe a l’apport d’un tissu autologue. La presence d’une coque periprothetique, la douleur, l’aspect fige du sein et l’asymetrie mammaire etaient les motifs d’insatisfaction les plus frequents. Avec un recul moyen de 2,6 ans, les patientes ayant beneficie d’une conversion autologue etaient globalement plus satisfaites de l’aspect de leurs seins que les patientes ayant conserve un implant mammaire (p Conclusion En cas de mauvais resultat esthetique ou fonctionnel d’une reconstruction mammaire par implant, le retrait de la prothese associe a une reconstruction autologue donne de meilleurs resultats en termes de bien-etre et de satisfaction que le changement d’implant.

Zusammenfassung Einleitung Minimalinvasive und narbensparende Operationsmethoden gehen in der plastischen Brustchirurgie in Bezug auf die mit der Narbenbildung und Narbensichtbarkeit einhergehende Ästhetik meist mit deutlichen Vorteilen einher. Zudem werden auch Vorteile hinsichtlich Heilung und Erholungszeit beobachtet, weswegen narbensparende Techniken bei der Brustverkleinerung und Mastopexie bereits lange etabliert und gefragt sind. Moderne Weiterentwicklungen von Silikonimplantaten und neue, angepasste chirurgische Techniken können es nun ermöglichen, minimalinvasive und narbensparende Techniken auch bei der Brustvergrößerung mit ähnlichen Vorteilen anzuwenden. Methode In eine retrospektive Studie wurden 252 Patientinnen eingeschlossen, bei welchen in einen Zeitraum von zwei Jahren eine narbensparende Brustvergrößerung über einen inframammären Zugang durchgeführt wurde. Erfasst wurden die Implanttalage, die Größe, die Form und etwaige postoperative Komplikationen. Darüber hinaus wurden alle Patienten anhand des Breast-Q-Fragebogens (Augmentationsmodul) zu ihren Erfahrungen vor und ein Jahr nach der Operation befragt. Der Schwerpunkt lag hierbei auf dem Selbstwertgefühl (prä- und postoperativ) und der Zufriedenheit mit dem Ergebnis einer Brustvergrößerung unter besonderer Berücksichtigung der Narbe. Ergebnisse Die Bewertung des Operationsergebnisses und der Narbe war durchweg positiv. Es gab keine Komplikationen hinsichtlich des chirurgischen Zugangs, der Narbe oder des Implantats. Alle Patientinnen wiesen auf der Breast-Q-Skala von 0–100 eine signifikante Steigerung der Lebensqualität (Psychischen Wohlbefindens: 44 auf 77) auf und waren mit dem Ergebnis der Brustvergrößerung (Zufriedenheit mit den Brüsten: 28 auf 80; Zufriedenheit mit dem Ergebnis: 89 von 100) unter Berücksichtigung der Narbe zufrieden. Schlussfolgerung Die narbensparende (Minimal-Scar) Brustvergrößerung erfordert zwar einen größeren technischen Aufwand und operative Erfahrung, die Ergebnisse sind jedoch sowohl klinisch als auch psychologisch durchweg positiv und vielversprechend.

Purpose: The aim of this study is to evaluate the influence of patient demographics, operative techniques and post-operative care on patient satisfaction after breast reduction operations were evaluated in this study. Materials and Methods: Patients who undergo breast reduction surgery were offered to fulfil Breast-Q reduction module survey in pre-operative and post-operative sixth month period. Patient data such as age, height, weight, smoking, marital status and parenting have been recorded. Operative variances such as drain use and cutaneous stitches and complications, post-operative discharge days, staying in a private room were recorded with post-operative survey module. Results: Seventy-six patients were included in this study. The average age was 45.8 and mean body mass index (BMI) was 29.2. Post-operative satisfaction with breasts, psychosocial, sexual and physical wellbeing scores were significantly higher than pre-operative scores. Older women had higher pre-operative scores from satisfaction with breasts and psychosocial wellbeing. Younger patients and normal weight patients had higher scores from post-operative physical wellbeing. Satisfaction with breasts, sexual and physical wellbeing, satisfaction with information, surgeon and medical stuff scores were significantly lower in patients who had a post-operative complication.Conclusion: Surgery without complications is the most powerful factor that increases patient satisfaction. Patient demographics such as age and BMI can be used for patient selection for higher patient satisfaction., Amaç: Bu çalışmada meme küçültme amelyiatı sonrası, hasta demografik özellikleri, ameliyat teknikleri ve ameliyat sonrası bakımın hasta memnuniyetine etkisi değerlendirilmiştir.Gereç ve Yöntem: Meme küçültme ameliyatı geçiren hastalar arasından, ameliyat öncesi ve ameliyat sonrası altıncı aylık dönemde Breast-Q meme redüksiyonu modülü anketi doldurmayı kabul eden hastalar çalışmaya dahil edildi. Hastaların evlilik durumları, çocuk sahibi olup olmadıkları, sigara kullanımı, boy ve kiloları, yaşları ameliyat öncesinde sorularak kaydedildi. Ameliyat sonrası dren kullanılıp kullanılmadığı, cilt dikişleri olup olmadığı, herhangi bir komplikasyon gelişip gelişmediği, postoperatif yatış gün sayısı, hastanede kaldığı odada başka hasta bulunup bulunmadığı sorgulanarak kayıt altına alındı. Bulgular: Çalışmaya 76 hasta dahil edildi. Ortalama yaş 45.8 ve ortalama vücut kitle indeksi (VKİ) 29.2 idi. Ameliyat sonrası memelerden tatmin, psikososyal, cinsel ve fiziksel iyilik hali puanları ameliyat öncesi puanlardan anlamlı derecede yüksekti. Yaşlı kadınlarda memelerden memnuniyet ve psikososyal iyilik hali ameliyat öncesi puanlarda daha yüksekti. Genç hastalar ve normal kilolu hastalar ameliyat sonrası fiziksel iyilikten daha yüksek puan aldı. Ameliyat sonrası komplikasyonu olan hastalarda memelerden memnuniyet, cinsel ve fiziksel iyilik hali, bilgi memnuniyeti, cerrah ve tıbbi malzeme puanları anlamlı olarak düşüktü.Sonuç: Komplikasyon olmayan cerrahinin, hasta memnuniyetini artıran en güçlü faktör olduğu görüldü. Yaş ve VKİ gibi hasta demografisi bilgileri, hasta memnuniyetini arttırmak için hasta seçiminde kullanılabilecek kriterlerdir.

The objective of this study was to document a patient’s evaluation after breast augmentation using BREAST-Q. The study was conducted in a private cosmetic surgery setup among female patients undergoing breast augmentation silicone implant surgery or fat transfer. All the surgeries were performed by a single surgeon under general anesthesia. Three parameters of BREAST-Q were noted preoperatively and after 9months. All the data were analyzed statistically. The mean age of the patients was 28.6 years. The average implant volume was 331 mL (range, 250-455 mL). The patients undergoing fat transfer had an average of 391.7 mL (range, 295-450 mL) injected on each side. There was a statistically significant difference noted in the scores preoperatively and postoperatively. The use of validated survey instruments plays an important role in improving patient-reported outcomes. Breast augmentation with fat transfer was shown to have higher patient satisfaction using BREAST-Q.

Objectives: We aimed to determine the relation between breast reconstruction method, patient satisfaction, and surgeon reported cosmetic outcome among women who underwent breast reconstruction after mastectomy.Study Design: A cross-sectional study of patients treated between 2006 and 2010.Main Outcome: Women's satisfaction with cosmetic outcomes after breast reconstruction.Measures: Cosmetic outcomes were evaluated by (1) women using the Breast-Q to rate satisfaction with breasts outcomes, and (2) an independent panel using the Strasser score. The relationships between the Breast-Q rating, Strasser scores, and breast reconstruction methods, including laterality and timing, were evaluated by Mann-Whitney U tests, Spearman's rank correlations, and Wilcoxon signed-rank tests.Results: Ninety-four women were included. Patients were more satisfied with their breasts if they had undergone autologous, unilateral, or secondary breast reconstruction compared with those who underwent alloplastic, bilateral, or primary breast reconstruction (p-values 0.008, 0.011, and 0.001, respectively). The Strasser system did not reveal significant cosmetic differences, with all breast reconstructions graded as mediocre or poor.Conclusions: Patient satisfaction with breast outcomes, as measured by the Breast-Q, was described as mediocre or poorly reflected by the Strasser score. If doctors are to support patients to make informed decisions on the optimal method of breast reconstruction, we need a more sensitive, comprehensive tool reflecting patients' cosmetic outcomes.

(1) Background: Mastectomy is the surgical treatment of choice in 20–30% of women with breast cancer. In addition, more women are undergoing risk-reducing mastectomies. It is necessary to study these women’s quality of life and satisfaction after surgery, as studies report high percentages of dissatisfaction with the results. The publication of the BREAST-Q© questionnaire in 2009 provided a valuable tool to measure these results. (2) Methods: Descriptive, cross-sectional study of 70 patients who underwent mastectomy and breast reconstruction, both therapeutic and prophylactic, in the last 10 years to whom the BREAST-Q© 2.0-Reconstruction Module questionnaire was provided for completion. (3) Results: The sexual satisfaction scale was the lowest score of the entire questionnaire (51.84 ± 21.13), while the highest score was obtained on the satisfaction with the surgeon scale (91.86 ± 18.11). The satisfaction with care scales showed the importance of the evaluation of these items for future studies. More than half of the patients of the study (51.5%) underwent at least one reoperation after the first surgery, with an average of one (1.15) intervention per patient and a maximum of five. (4) Conclusions: Mastectomy and breast reconstruction have a high negative impact on the sexual well-being of patients. The high percentage of reoperations is a factor to consider because of its possible influence on these patients’ quality of life and satisfaction.

An understanding of patient expectations predicts better health outcomes following breast reconstruction. No study to date has examined how patient expectations for breast reconstruction and preoperative health-related quality of life vary with time since breast cancer diagnosis.Women consulting for breast reconstruction to a single surgeon's practice over a 13-month period were enrolled in this cross-sectional study. Patients were asked to prospectively complete the BREAST-Q expectations and preoperative reconstruction modules. A retrospective chart review was then performed on eligible patients, and patient demographics, cancer-related factors, and comorbidities were collected. BREAST-Q scores were transformed using the equivalent Rasch method. Multivariate linear regression models were constructed to assess the association between BREAST-Q scores and time since cancer diagnosis.Sixty-five patients met inclusion criteria for analysis and are characterized by a mean age of 53 ± 11 (34-79) years and a mean body mass index of 28 ± 6 (19-49). Most patients were treated by mastectomy (58%) or lumpectomy (23%). At the time of retrospective chart review, 29 (43%) patients had undergone reconstruction, most of which were delayed (59%). The mean latency from cancer diagnosis to reconstruction was 685 ± 867 days (range: 28-3322 days). Latency from cancer diagnosis to reconstruction was associated with a greater expectation of pain (β = 0.5; standard error [SE] = 0.005; 95% confidence interval [CI]: 0.003-0.027;Delaying breast reconstruction may negatively impact patient expectations of postoperative pain and recovery. Educational interventions aimed at understanding and managing patient expectations in the preoperative period may improve health-related quality of life and patient-related outcomes following initial breast cancer surgery.La compréhension des attentes des patientes est prédictive de meilleurs résultats cliniques après une reconstruction mammaire. Jusqu’à présent, aucune étude n’a porté sur la manière dont les attentes des patientes à l’égard de la reconstruction mammaire et de la qualité de vie liée à la santé avant l’opération varient dans le temps à compter du diagnostic de cancer du sein.Les femmes qui ont consulté le cabinet d’un seul chirurgien en vue d’une reconstruction mammaire sur une période de 13 mois ont participé à la présente étude transversale. Les patientes ont été invitées à remplir de manière prospective les modules BREAST-Q sur les attentes préopératoires et la reconstruction. Les chercheurs ont ensuite procédé à un examen rétrospectif des dossiers des patients admissibles, puis ont colligé des données sur la démographie des patients, les facteurs liés au cancer et les morbidités associées. Ils ont transformé les scores BREAST-Q à l’aide du modèle de Rasch équivalent. Ils ont construit des modèles de régression linéaire multivariés pour évaluer l’association entre les scores BREAST-Q et la période écoulée depuis le diagnostic de cancer.Soixante-cinq patientes respectaient les critères d’inclusion. Elles se caractérisaient par un âge moyen de 53 ± 11 ans (34 à 79 ans) et un indice de masse corporelle moyen de 28 ± 6 (19 à 49). La plupart des patientes ont été traitées par mastectomie (58 %) ou lumpectomie (23 %). Au moment de l’analyse rétrospective des dossiers, 29 (43 %) avaient subi une reconstruction, dont la plupart avaient été retardées (59 %). La latence moyenne entre le diagnostic de cancer et la reconstruction était de 685 ± 867 jours (plage de 28 à 3 322 jours). La latence entre le diagnostic de cancer et la reconstruction s’associait à une plus grande anticipation de la douleur (β=0,5; ÉT=0,005; intervalle de confiance [IC] à 95 % de 0,003 à 0,027;Le report de la reconstruction mammaire peut avoir un effet négatif sur l’anticipation des patientes à l’égard de la douleur préopératoire et de la convalescence. Des interventions pédagogiques pour comprendre et gérer les attentes des patientes pendant la période préopératoire peuvent améliorer la qualité de vie liée à la santé et les résultats cliniques des patientes après la chirurgie initiale d’un cancer du sein.

BACKGROUND: BREAST-Q is a patient-reported outcome (PRO) that has been designed to evaluate perception outcomes among women undergoing different types of breast surgery, the modules include evaluation for mastectomy, breast reconstruction, augmentation, reduction/mastopexy and breast-conserving therapy. OBJECTIVES: Generate a translated version that is conceptually equivalent to the original version and to validate for Mexican population. METHODS: A linguistic and psychometric validation was performed in 494 women. We carry out pre and postoperative test. Reliability and internal consistency were performed by Cronbach's alpha and intraclass correlation coefficient (ICC). RESULTS: The results of patient testing, number of participants, acceptability and reliability are shown in table 1. The average scores were in all cases >0.80. Summary of BREAST-Q validation analysisN =494Module=nMean age(range)Time to completion Test(minutes) average(range)Time to completion Retest(minutes) average(range)Number of itemsNumber of missing itemsCronbach's Alpha min-max*Test-Retest ICC min-max*Mastectomy=160Pre=6248(26-76)7.8(2-20)6.4(3-20)3700.81-0.940.72-0.94Post=9852(32-78)13(4-40)11(4-28)6310.87-0.970.87-0.96Breast Conserving Therapy=153Pre=8150(21-78)7(2-17)5.2(2-13)3220.88-0.950.82-0.95Post=7255(37-73)18.7(5-44)15.4(6-29)8720.92-0.980.92-0.98Reconstruction=181Pre=6544(23-64)7.9(3-22)6.4(2-20)4220.90-0.970.90-0.97Post=9246(24-74)18.5(8-41)15.7(5-42)11610.86-0.990.85-0.99Lattisimus Dorsi=2445(33-74)5(1-18)4(2-10)1910.95-0.960.96-0.96We report the low and the high value between all sub scales, per questionnaires The internal consistency and reproducibility support the reliability of the instrument; all of the scores were acceptable. DISCUSSION: The importance of measurements quality of life in patient whit cancer, become an essential end-point, we need validated tools that help us improve our performance in different methods of treatments. Is the first validation study of an instrument that measures the impact of surgical treatment on the quality of life of breast cancer patients in Mexico, our results support the equivalent Spanish version for Mexican population. Breast-Q will provide valuable metrics for a surgeon team to document and measure their clinical performance and improve quality of healthcare in our Hispanic patients. CONCLUSIONS: The Mexican Spanish version of tree Modules of Breast-Q is reliable and easy to implement in the population with breast cancer in different scenarios in México with the advantage to measure the quality of life and satisfaction on our population with a locally advanced stage that will help to improve quality of healthcare. The high acceptability of the questionnaire demonstrate that the version is well accepted for our population so we will include a significant number of patient in our country; therefore, more hospital centers will be invited to participate for further studies that allow us to evaluate the population in Latin America and thus compare our results. Citation Format: Bargalló-Rocha J, Gutiérrez-Zacarías L, Gallargo-Alvarado L, Maciel-Miranda J, Shaw-Dulin R, Esparza-Arias N, Figueroa-Padilla J, Vazquez-Romo R, Robles-Vidal C, Drucker-Zertuche M, Cabrera-Galeana P, Cantu-De Leon D. The BREAST-Q: Translation and validation for Mexican population [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-07.

The role of breast oedema in breast reconstruction is unknown. Therefore, our aim was to investigate local tissue water (LTW) and breast oedema-related symptoms in breasts reconstructed with either an expander prosthesis (EP) or with a deep inferior epigastric perforator (DIEP) flap at a minimum of one year postoperatively. Sixty-eight patients randomised to breast reconstruction with an EP or DIEP flap completed follow-up. Objective evaluation was performed at a mean of 25 (standard deviation, SD 9.5) months following breast reconstruction, and included measurements of breast volume and LTW with the MoistureMeterD® instrument. The patients completed the BREAST-Q questionnaire pre- and postoperatively. No significant differences in LTW were found when comparing EP and DIEP flap reconstructed breasts. The reconstructed breasts had an increase in LTW compared with the non-operated contralateral breasts. The BREAST-Q responses related to breast oedema symptoms were overall low and the median responses ranged from 1 to 2. A score of 1 indicated that symptoms were experienced ‘None of the time’. Our findings indicate that mastectomy followed by breast reconstruction inflicts damage on the lymphatic system, shown as an increase in LTW. However, no breast oedema-related symptoms were reported in the BREAST-Q questionnaire, and therefore, we consider our objective results to be below a potential threshold for symptomatic breast oedema. A threshold for clinical indication of breast oedema remains to be defined.

Breast cancer is the most frequently diagnosed tumor in women; globally, it accounts 23% of all cancer deaths. Breast reconstruction after oncologic surgery has become crucial to enhance patients' quality of life and alleviate the psychological distress related to the disease. The aim of this study was to assess quality of life and esthetic satisfaction of breast cancer patients undergoing muscle-sparing skin-reducing breast reconstruction (MS-SR) with pre-pectoral implants.Sixty-three patients who met definite oncological and reconstructive criteria were enrolled in the study. Specific questionnaires (EORTC QLQ-C30, QLQ-BR23) were administered preoperatively, 1, and 12 months after MS-SR breast reconstruction to evaluate patients' QoL. Satisfaction with procedure and related Quality of Life were assessed through BREAST-Q questionnaire preoperatively and 12 months after surgery.Sixty-three breast cancer patients underwent MS-SR. Seventy-eight procedures were carried out; in 15 patients a bilateral reconstruction was performed. One month after surgery, both EORTC QLQ-C30 and QLQ-BR23 average scores demonstrated a slight drop since preoperative values, but a significant improvement in QoL was documented 12 months after BR (Muscle-sparing skin-reducing breast reconstruction is an established and reliable technique. EORTC QLQ-C30, QLQ-BR23 and BREAST-Q scores showed an improvement of patients' QoL and esthetic satisfaction. Reduction of pain and other surgery-related symptoms are cornerstones of patient well-being. Both physicians and patients should build a thorough awareness of the silver lining of muscle-sparing skin-reducing breast reconstruction based on the high safety profile and highly satisfactory patient-reported results.

Supplemental Digital Content is available in the text., Background: Implant-based breast augmentation is the number one cosmetic procedure performed in the United States. However, it is associated with relatively high revision rates, reaching up to 24% at 4 years. This case series presents our experience in implant explantation with simultaneous breast augmentation using fat. Methods: This case series was conducted by the authors in Cairo, Egypt, during the period from January 2018 to June 2019. Following a detailed data collection, careful physical examination was done. Implant-to fat conversion was done for all cases. None of the cases needed >1 session of fat injection following the implant removal. Size of the implants removed ranged from 200 -350 cm3 (average of 310). Volume of fat injected ranged from 300 to 550 ml (average of 430). Patients' satisfaction was evaluated using the BREAST-Q questionnaire. Results: Twenty patients were included, with a mean age of presentation of 33.1 years (range, 26 -42 years; SD, 5.3). Mean body mass index was 26.9 kg/m2 (range, 24 -30; SD, 1.9). Implant complications were as follows: capsular contracture (10cases), implant migration (3 cases), breast asymmetry (3 cases), poor aesthetic outcome (3 cases), and palpable implant (1 case). Overall patient's satisfaction was evaluated by the BREAST-Q 1-year following surgery. The overall satisfaction score was 3.8, where a score of 4 indicates very satisfied and a score of 1 indicates very dissatisfied. Conclusions: Implant-to-fat conversion is a good option for complicated breast implant cases, with good long-term results and excellent patient’s satisfaction as verified by the BREAST-Q.

Background and aim : Immediate reconstruction with an omental flap is a recognized suitable method for a full thickness breast reconstruction or implant coverage for well selected cases of nipple or skin-sparing mastectomies as well as cases of skin reducing mastectomies. Authors’ aim is the evaluation of indications and limitations of this technique with an original approach, also based on the analysis of patients’ global satisfaction using the BREAST-Q 2.0© survey. Materials and methods : From January 2014 to March 2018, 12 women aged between 29 to 67 years old (mean age: 49 years) underwent immediate breast reconstruction alone or with definitive implant covered by a pedicled omental flap. All of them were asked to fill out the BREAST-Q© 2.0 survey. Conclusions : The careful analysis of the cases shows that the indications for the immediate breast reconstruction based on the omental flap with a minimal resulting donor site morbidity are strictly linked to its limitations, which are correctly reported in the study, but in the same way it suggests that patients who underwent implant-based immediate breast reconstruction with omental flap reported significant improvements in satisfaction and health-related quality of their life.

Leczenie raka piersi stanowi ważne zagadnienie dla onkologów i chirurgów plastycznych. Dokonuje się znaczący postęp dotyczący wiedzy i sposobów terapii tego nowotworu. Leczenie niejednokrotnie wymaga rekonstrukcji amputowanej piersi. Współczesne metody są coraz doskonalsze i coraz bardziej dopasowane do potrzeb pacjentki. Jednocześnie obserwowany jest stały wzrost zainteresowania oceną jakości życia po wykonywanych procedurach medycznych. Taki trend obserwowany jest szczególnie w chirurgii plastycznej, gdzie prosta ocena ilości powikłań nie jest wystarczająca. Aby skutecznie pomagać, istnieje potrzeba skrupulatnej oceny leczenia dokonanej przez pacjentki. Celem pracy jest omówienie i przedstawienie zastosowania kwestionariusza BREAST-Q. Pozwala on na ocenę zadowolenia chorej ze zrekonstruowanej piersi, satysfakcji z całego procesu leczenia rekonstrukcyjnego i opieki medycznej. W pracy przedstawiono wyniki badania jakości życia kwestionariuszem BREAST-Q u 20 pacjentek po wtórnej rekonstrukcji piersi płatem DIEP bez usuwania żebra podczas uzyskiwania dostępu do naczyń dawczych. Ocena jakości życia pacjentek służy chirurgowi zajmującemu się rekonstrukcją do analizy swojej pracy. Pozwala na głębsze zrozumienie potrzeb i lepsze doradzanie kolejnym pacjentkom podczas konsultacji przedoperacyjnych. Uzyskane wyniki mogą być też przydatne dla płatnika przy podejmowaniu decyzji odnośnie do poziomu refundacji poszczególnych procedur.

Background: Breast reconstruction is achieved through a series of surgical procedures often concluded with nipple-areolar reconstruction tattoo. The purpose of the tattoo is to increase the patients' satisfaction with the appearance of the breast, however, no published studies quantitatively compare patient satisfaction before vs. after tattoo. In recent times nurse practitioners are increasingly performing this specialised procedure previously undertaken by the plastic surgeon, but there is no evidence to compare patient satisfaction according to clinician. Purpose: The objectives of this study are to examine patient satisfaction pre- and post-nipple-areolar tattooing utilising a validated patient-reported outcome measure the BREAST-Q, and to identify any differences in patient satisfaction between the nurse practitioner and plastic surgeon. Methods: Data was collected from all breast reconstruction patients who underwent nipple-areolar reconstruction tattooing over a six-year period in a dedicated Breast Reconstruction Unit and had completed a pre- and post-tattoo BREAST- Q questionnaire. Analysis of data included paired t-test of pre- and post-tattoo scores and ANCOVA to compare clinicians and tattoo laterality. Results: 93 patients with completed pre- and post-tattoo questionnaires within the date criteria were included from the 204 patientswho had a nipple-areolar tattoo. There was a significant improvement in patient satisfaction with nipple reconstruction from pre-tattoo (m = 74.4) to post-tattoo (m = 81.0), p = 0.013 (2-tailed), with no significant difference between clinicians. Conclusion: Patients reported through completion of the BREAST-Q, that nipple-areolar tattooing significantly improves satisfaction with their nipple reconstruction. Keywords: BREAST-Q, Patient-reported outcomes measure, Breast reconstruction, Nipple-areolar reconstruction tattooing

Challenges of direct-to-implant breast reconstruction (BR) are to achieve sufficient implant coverage and lower pole projection. We assessed reoperation rates, long-term patient satisfaction and aesthetic outcome after direct-to-implant BR without acellular dermal matrix (ADM) in women with high breast cancer risk.Women who underwent bilateral skin or nipple-sparing mastectomy and immediate direct-to-implant BR between 1994 and 2006 completed a survey on reoperations and the Breast-Q Reconstruction questionnaire. Photographs taken during follow-up were rated for long-term aesthetic outcome (scale 1-10) by five plastic surgeons. Outcomes were compared between women who never underwent unanticipated reoperations after immediate BR and women who underwent one or more reoperations, adjusted for potential confounders using multivariable linear regression.Of 143 women, 70 (49%) were never reoperated and 73 (51%) had undergone reoperations. Median follow-up was 12 years in both groups (range 7-17 and 6-19 years, respectively). Baseline characteristics were comparable except for history of prophylactic oophorectomy with 81% in the no-reoperations group versus 66% in the reoperated group (p = .03). Breast-Q scores were 59.7 ± 17.3 versus 58.0 ± 17.8 (p = .67) for 'satisfaction with breasts' and 71.1 ± 20.3 versus 68.1 ± 22.9 (p = .47) for 'satisfaction with outcome' in the no-reoperation versus reoperation group, respectively. Aesthetic outcome was scored 5.8 ± 1.1 in the no-reoperation group versus 5.3 ± 1.3 in the reoperation group (p = .01).The single-stage intent did not prevent unanticipated surgical reinterventions in 51% of the patients. Long-term patient satisfaction was reasonable and not affected by reoperations. Aesthetic outcome, however, was only poor to reasonable and scores were significantly lower in the reoperated group.

Breast reconstruction plays an important role in improving the quality of life of patients with breast cancer. The aim of this study is to verify if there is a difference in patient’s satisfaction and in body perception following monolateral and bilateral mastectomy with breast reconstruction. The study population were 144 women who had undergone mastectomy and breast reconstruction at our hospital between 2005 and 2016. They filled out BREAST-Q post-operative module after almost 1 year from breast reconstruction. We administered the questionnaire electronically almost 1 year after surgery for each procedure. This cross-sectional study compared two cohorts in which 121 women underwent monolateral mastectomy and breast reconstruction with or without contralateral adjustment and 23 women underwent bilateral mastectomy and breast reconstruction. After reconstruction procedures, patients that underwent bilateral mastectomy were more satisfied than monolateral mastectomy group in satisfaction with appearance of breast (P

Background Animation deformity can occur following subpectoral breast reconstruction and is an oft-touted rationale for prepectoral reconstruction. Despite increasing recognition, there is a paucity of patient-reported outcome studies in women with animation deformity. Methods Women presenting after subpectoral implant-based breast reconstruction were evaluated for animation deformity. Video analysis and quantitative deformity assessment were performed in conjunction with BREAST-Q surveys. BREAST-Q data were compared to our quantitative animation grading scale to assess the relationship between animation severity and patient-reported outcomes. Results One hundred forty-one subpectoral breast reconstructions met inclusion criteria. Average scores were 67.8 ± 17.9 of 100 for satisfaction with breasts and 78.3 ± 14.1 of 100 for physical well-being. Animation deformity severity did not correlate with satisfaction with breasts (p = 0.44). Physical well-being, particularly pain-related questions, increased with increasing animation (p = 0.01); specifically, patients reported significantly less pulling, nagging, and aching in the breast (p = 0.01, p = 0.001, and p = 0.004, respectively). Patients with the least and most severe animation deformity had significantly higher numbers of revision procedures (0.89 and 1.03 procedures, respectively) compared with patients with intermediate deformity (0.49 procedures; p = 0.01 and p = 0.009, respectively). Conclusions Although pectoralis release creates a more mobile-and more animating-reconstruction, this same release may lead to less pain because muscle is no longer contracting against a fixed space. This may lead to two distinct origins of subpectoral revision: (1) patients in pain (but low animation) and (2) patients with visibly distorted animation (but low pain). Clinical question/level of evidence Risk, II.

One of the goals of immediate breast reconstruction (IBR) is to satisfy the patient's outcome. Recent studies therefore tended to focus on the patient's perception of the care and on the impact on quality of life using patients-reported-outcome-measures (PROMs), able to measure the health status directly without the clinician's interposition. We present a preliminary prospective study on 333 patients who underwent mastectomy with IBR in a two-year period, in a single Italian centre, using a dedicated PROMs, the BREAST-Q™, to determine the patient's satisfaction. We studied two groups of IBR: Group A (two-step with tissue-expander) and Group B (one-step: prosthesis/mesh) and conducted a pre- and post-operative comparison for each group to evaluate score-gain over time, and a group-score comparison to determine whether differences were significant between reconstruction types. Two-hundred-and-nine were actually enrolled and 132 completed all the questionnaires. The response rate was 62.8% and the compliance rate (completion of all the questionnaires) was 63.1%. In both groups all the analyzed domains worsened comparing the pre and post-operative period; the differences were statistically significant only for physical and sexual-wellbeing. In the comparison between the two groups, none of the detected differences reached the statistical significance. According to our experience, we can state that PROMs could improve the health concept redefining the variables to be monitored even if data is still insufficient to draw any definitive conclusion. PROMs can help surgeons and patients decide the most appropriate surgery for a particular patient-profile and to identify those who require further support.

Objective: Breast reconstruction following mastectomy can increase the quality of life of patients. Reconstruction methods can broadly be divided into implant-based and autologous tissue reconstruction. Patient-reported outcomes following breast reconstruction are one of the most important success parameters. In this systematic review and meta-analysis, we aimed to compare the two methods using the recognized Breast-Q questionnaire. Methods: We performed a systematic search in PubMed and EMBASE databases. Meta-analysis was performed on the five most commonly reported Breast-Q modules. RevMan 5.3 was used for statistical analysis. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Form for Cohort Studies. Results: The search strategy resulted in 219 studies of which nine studies were included in the analysis, yielding 2129 implant-based and 825 autologous breast reconstructions. Overall satisfaction with outcome as well as breast was significantly higher among patients with autologous breast reconstructions (mean Breast-Q difference between the two groups was 9.82 [3.09, 16.54], p = 0.004, and 10.33 [95% CI 5.93, 14.74], p

Background and Objectives The authors sought to study patient-reported outcomes following nipple-sparing mastectomy (NSM). Methods From 2008 to 2011, the BREAST-Q was administered to women undergoing NSM surgery for cancer treatment or risk-reduction prior to surgery and at 2 years after completion of reconstruction. The change in score over time and the impact of surgical indication, complication occurrence, and laterality on scores were analyzed. Results The BREAST-Q was prospectively administered to 39 women undergoing NSM for cancer treatment (n = 17) or risk-reduction (RR) (n = 22). At 2 years after operation, median overall satisfaction with breasts was 75 (IQR = 67,100). There were significant postoperative increases in scores for overall satisfaction with breasts (+8, P = 0.021) and psychosocial well-being (+14, P = 0.003). Postoperatively, RR patients had significantly higher scores for psychosocial wellness, physical impact (chest), and overall satisfaction with outcome compared to cancer treatment patients (P