Patient satisfaction with breast reconstruction using musculocutaneous flap from latissimus dorsi versus from rectus abdominis
a cross-sectional study
Keywords:
Surgery, plastic, Mammaplasty, Breast neoplasms, HealthAbstract
BACKGROUND: Breast cancer is the second most frequent type of cancer worldwide and the most com- mon type among women. The treatment for this condition has evolved over recent decades with thera- peutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients’ quality of life. Our goal here was to compare patients’ satisfaction scores after they underwent breast reconstruction using mus- culocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING: Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS: Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS: The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION: Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.
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References
The National Cancer Institute. Tipos de câncer. Câncer de Mama. Available from: https://www.inca.gov.br/tipos-de-cancer/cancer-de-mama. Accessed in 2018 (Aug 9).
Veiga DF, Sabino Neto M, Ferreira LM, et al. Quality of life outcomes after pedicled TRAM flap delayed breast reconstruction. Br J Plast Surg. 2004;57(3):252-7. PMID: 15006527; doi: 10.1016/j.bjps.2003.12.029.
Veiga DF, Veiga-Son J, Ribeiro LM, et al. Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery. Plast Reconstr Surg. 2010;125(3):811-7. PMID: 20195109; doi: 10.1097/PRS.0b013e3181ccdac5.
Hopwood P, Haviland JS, Sumo G, et al. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol. 2010;11(3):231-40. PMID: 20138809; doi: 10.1016/S1470-2045(09)70382-1.
Brandberg Y, Malm M, Rutqvist LE, Jonsson E, Blomqvist L. A prospective randomised study (named SVEA) of three methods of delayed breast reconstruction. Study design, patients’ preoperative problems and expectations. Scand J Plast Reconstr Surg Hand Surg. 1999;33(2):209-
PMID: 10450579.
Harcourt MD, Rumsey NJ, Ambler NR, et al. The psychological effect of mastectomy with or without breast reconstruction: a prospective, multicenter study. Plast Reconstr Surg. 2003;111(3):1060-8. PMID: 12621175; doi: 10.1097/01.PRS.0000046249.33122.76.
Archangelo SCV, Neto MS, Veiga DF, et al. Impacto de fatores clínico-epidemiológicos sobre a opção de reconstrução mamária após mastectomia. Rev Bras Mastol. 2006;16(3);113-6. Available from: http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=LILACS&lang=p&nextAction=lnk&exprSearch=562226&indexSearch=ID. Accessed in 2018 (Aug 9).
Dutra AK, Sabino Neto M, Garcia EB, et al. The role of transverse latissimus dorsi musculocutaneous flap immediate breast reconstruction. EUR J Plast Surg. 2009;32(6):293-99. doi: 10.1007/s00238-009-0366-z.
Min SY, Kim HY, Jung SY, et al. Oncological safety and quality of life associated with mastectomy and immediate breast reconstruction with latissimus dorsi myocutaneous flap. Breast J. 2010;16(4):356-61. PMID: 20545939; doi: 10.1111/j.1524-4741.2010.00941.x.
van Geel AN, Lans TE, Haen R, Tjong Joe Wai R, Menke-Pluijmers MB. Partial mastectomy and m. latissimus dorsi reconstruction for radiation-induced fibrosis after breast-conserving cancer therapy. World J Surg. 2011;35(3):568-72. PMID: 21165619; doi: 10.1007/s00268-010-0911-8.
Anderson RC, Cunningham B, Tafesse E, Lenderking WR. Validation of the breast evaluation questionnaire for use with breast surgery patients. Plast Reconstr Surg. 2006;118(3):597-602. PMID: 16932165; doi: 10.1097/01.prs.0000233040.82665.15.
Ferreira LF, Sabino MN, Silva MMA, Resende VCL, Ferreira LM. Portuguese language translation, cultural adaptation and validation of the Breast Evaluation Questionnaire [Tradução para a língua portuguesa, adaptação cultural e validação do Breast Evaluation Questionnaire]. Rev Bras Cir Plást. 2013;28(2):270-75. doi: 10.1590/s1983-51752013000200017.
Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. O Mini-Exame do Estado Mental em uma população geral: impacto do status educacional [The Mini-Mental State Examination in a general population: impact of educational status]. Arq Neuropsiquiatr. 1994;52(1):1-7. PMID: 8002795.
Siegel S, Castellan Jr NJ. Estatística não paramétrica para ciências do comportamento. 2a ed. Porto Alegre: Artmed; 2006. ISBN-10: 8536307293; ISBN-13: 978-8536307299.
Hopwood P, Haviland J, Mills J, et al. The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial). Breast. 2007;16(3):241-51. PMID: 17236771; doi: 10.1016/j.breast.2006.11.003.
Iglesias M, Gonzalez-Chapa DR. Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing mastectomy total: report of 14 cases. Aesthetic Plast Surg. 2013;37(4):719-27. PMID: 23657725; doi: 10.1007/s00266-013-0131-3.
Elder EE, Brandberg Y, Björklund T, Rylander R, et al. Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast. 2005;14(3):201-8. PMID: 15927829; doi: 10.1016/j.breast.2004.10.008.
Ditsch N, Bauerfeind I, Vodermaier, et al. A retrospective investigation of women’s experience with breast reconstruction after mastectomy. Arch Gynecol Obstet. 2013;287(3):555-61. PMID: 23090185; doi: 10.1007/s00404-012-2590-1.
Zhong T, McCarthy C, Min S, et al. Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer. 2012;15;118(6):1701-9. PMID: 22025176; doi: 10.1002/cncr.26417.
De Gournay E, Bonnetain F, Tixier C, et al. Evaluation of quality of life after breast reconstruction using an autologous myocutaneous flap latissimus dorsi. Eur J Surg Oncol. 2010;36(6):520-7. PMID: 20452169; doi: 10.1016/j.ejso.2010.04.008.
Dutra AK, Neto MS, Garcia EB, et al. Patients’ satisfaction with immediate breast reconstruction with a latissimus dorsi musculocutaneous flap. J Plast Surg Hand Surg. 2012;46(5):349-53. PMID 22931105; doi: 10.3109/2000656X.2012.704726.
Macadam SA, Ho AL, Lennox PA, Pusic AL. Patient-reported satisfaction and health-related quality of life following breast reconstruction: a comparison of shaped cohesive gel and round cohesive gel implant recipients. Plast Reconstr Surg. 2013;131(3):431-41. PMID: 23142936; doi: 10.1097/PRS.0b013e31827c6d55.
Chun YS, Sinha I, Turko, et al. Comparison of morbidity, functional outcome, and satisfaction following bilateral TRAM versus bilateral DIEP flap breast reconstruction. Plast Reconstr Surg. 2010;126(4):1133-41. PMID: 20555301; doi: 10.1097/PRS.0b013e3181ea42d3.
Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36(15):1938-43. PMID: 11000574; doi: 10.1016/S0959-8049(00)00197-0.
Temple CL, Ross DC, Kim S, et al. Sensibility following innervated free TRAM flap for breast reconstruction: Part II. Innervation improves patient-rated quality of life. Plast Reconstr Surg. 2009. PMID: 20009826; doi: 10.1097/PRS.0b013e3181b98963.
Momoh AO, Colakoglu S, Westvik TS, et al. Analysis of complications and patient satisfaction pedicled rectus abdominis myocutaneous and deep inferior epigastric perforator flap breast reconstruction. Ann Plast Surg. 2012;69(1):19-23. PMID: 21659842; doi: 10.1097/SAP.0b013e318221b578.
Brandberg Y, Malm M, Blomqvist L. A prospective and randomized study, “SVEA,” comparing effects of three methods for delayed breast reconstruction on quality of life, patient-defined problem areas of life, and cosmetic result. Plast Reconstr Surg. 2000;105(1):66-74. PMID: 10626972; doi: 10.1097/00006534-200001000-00011.
Veiga DF, Neto MS, Garcia EB, et al. Evaluations of the aesthetic results and patient satisfaction with the late pedicled TRAM flap breast reconstruction. Ann Plast Surg. 2002;48(5):515-20. PMID: 11981193.
Reefy S, Pattani N, Anderson A, et al. Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study. BMC Cancer. 2010;10:171. PMID: 20429922; doi: 10.1186/1471-2407-10-171.
Beesley H, Ullmer H, Holcombe C, Salmon P. How patients evaluate breast reconstruction after mastectomy, and why their evaluation often differs from that of their clinicians. J Plast Reconstr Aesthet Surg. 2012;65(8):1064-71. PMID: 22475685; doi: 10.1016/j. bjps.2012.03.005.
Cohen WA, Ballard TN, Hamill JB, et al. Understanding and Optimizing the Patient Experience in Breast Reconstruction. Ann Plast Surg. 2016;77(2):237-41. PMID: 26101986; doi: 10.1097/SAP.0000000000000550.
Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;20;32(9):919-26. PMID: 24550418; doi: 10.1200/JCO.2013.52.2284.
