Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Patient-Reported Quality of Life Following Direct-to-Implant Prepectoral and Subpectoral Breast Reconstruction Using BREAST-Q: A Randomized Controlled Trial

  • Diana L Dyrberg (Department of Plastic Surgery, Odense Universitetshospital) ;
  • Farima Dalaei (Department of Plastic Surgery, Odense Universitetshospital) ;
  • Martin Sollie (Department of Plastic Surgery, Odense Universitetshospital) ;
  • Camilla Bille (Department of Plastic Surgery, Odense Universitetshospital) ;
  • Vibeke Koudahl (Department of Plastic Surgery, Odense Universitetshospital) ;
  • Jens A Sorensen (Department of Plastic Surgery, Odense Universitetshospital) ;
  • Jorn B Thomsen (Department of Plastic Surgery, Odense Universitetshospital)
  • Received : 2022.05.18
  • Accepted : 2024.07.11
  • Published : 2024.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Direct-to-implant breast reconstruction (DIR) is becoming more and more accepted. There is a lack of high-quality studies assessing differences in patient-reported quality of life (QoL) between different implant placement methods. The aim of this randomized controlled (clinical) trial was to compare QoL between women reconstructed by sub- or prepectoral implant placement. Methods We included women over 18 years eligible for DIR. Patients were randomly assigned to reconstruction by subpectoral or prepectoral implant placement. Assessment of QoL and patient satisfaction was made using the BREAST-Q questionnaire for postmastectomy breast reconstruction and compared between the sub- and prepectoral reconstructed groups preoperatively and after 3 and 12 months of follow-up. Results A total of 42 women were allocated to sub- or prepectoral reconstruction with 21 patients in each group. There were no differences in patient characteristics between groups. Regarding all the selected BREAST-Q scales: (1) satisfaction with the reconstructed breast, (2) satisfaction with the breast implant, (3) satisfaction with the overall outcome, (4) psychosocial well-being, (5) sexual well-being, and (6) physical well-being-we found no significant differences between the two groups. Assessing each group independently we found, that in both groups sexual well-being improved after surgery postoperatively compared to the preoperative scores. Conclusion We found high satisfaction and QoL following both sub- and prepectoral breast reconstruction. We found no significant differences between groups suggesting both methods for DIR can be used. Despite our high-quality data, a larger sample size and longer postoperative follow-up are needed to further investigate the differences in QoL between sub- and prepectoral breast reconstruction.

Keywords

References

  1. Doherty C, Pearce S, Baxter N, et al. Trends in immediate breast reconstruction and radiation after mastectomy: a population study. Breast J 2020;26(03):446-453 https://doi.org/10.1111/tbj.13500
  2. Khoo A, Kroll SS, Reece GP, et al. A comparison of resource costs of immediate and delayed breast reconstruction. Plast Reconstr Surg 1998;101(04):964-968, discussion 969-970 https://doi.org/10.1097/00006534-199804040-00011
  3. Negenborn VL, Young-Afat DA, Dikmans REG, et al. Quality of life and patient satisfaction after one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage breast reconstruction (BRIOS): primary outcome of a randomised, controlled trial. Lancet Oncol 2018;19(09):1205-1214 https://doi.org/10.1016/S1470-2045(18)30378-4
  4. Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg 2005;55(03):232-239
  5. Casella D, Bernini M, Bencini L, et al. TiLoop® Bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series. Eur J Plast Surg 2014;37(11):599-604 https://doi.org/10.1007/s00238-014-1001-1
  6. Bloom J, Patel K, Cohen S, Chatterjee A, Homsy C. Prepectoral breast reconstruction: an overview of the history, technique, and reported complications. Open Access Surg. 2020;13:1-9 https://doi.org/10.2147/OAS.S201298
  7. Becker H, Lind JG II, Hopkins EG. Immediate implant-based prepectoral breast reconstruction using a vertical incision. Plast Reconstr Surg Glob Open 2015;3(06):e412 https://doi.org/10.1097/GOX.0000000000000384
  8. Spear SL, Bulan EJ, Venturi ML. Breast augmentation. Plast Reconstr Surg 2006;118(7, Suppl):188S-196S, discussion 197S-198S https://doi.org/10.1097/01.prs.0000247298.27098.7a
  9. Dyrberg DL, Gunnarsson GL, Bille C, Sorensen JA, Thomsen JB. A simple clinical assessment of breast animation deformity following direct-to-implant breast reconstruction. Arch Plast Surg 2019;46(06):535-543 https://doi.org/10.5999/aps.2019.00493
  10. Becker H, Fregosi N. The impact of animation deformity on quality of life in post-mastectomy reconstruction patients. Aesthet Surg J 2017;37(05):531-536 https://doi.org/10.1093/asj/sjw264
  11. Rebowe RE, Allred LJ, Nahabedian MY. The evolution from subcutaneous to prepectoral prosthetic breast reconstruction. Plast Reconstr Surg Glob Open 2018;6(06):e1797 https://doi.org/10.1097/GOX.0000000000001797
  12. Manrique OJ, Banuelos J, Abu-Ghname A, et al. Surgical outcomes of prepectoral versus subpectoral implant-based breast reconstruction in young women. Plast Reconstr Surg Glob Open 2019;7(03):e2119 https://doi.org/10.1097/GOX.0000000000002119
  13. Yang JY, Kim CW, Lee JW, Kim SK, Lee SA, Hwang E. Considerations for patient selection: prepectoral versus subpectoral implant-based breast reconstruction. Arch Plast Surg 2019;46(06):550-557 https://doi.org/10.5999/aps.2019.00353
  14. Porter ME. What is value in health care? N Engl J Med 2010;363(26):2477-2481 https://doi.org/10.1056/NEJMp1011024
  15. Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg 2012;129(02):293-302 https://doi.org/10.1097/PRS.0b013e31823aec6b
  16. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009;124(02):345-353 https://doi.org/10.1097/PRS.0b013e3181aee807
  17. Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg 2017;139(05):1046e-1055e https://doi.org/10.1097/PRS.0000000000003241
  18. Nigro LC, Blanchet NP. Animation deformity in postmastectomy implant-based reconstruction. Plast Reconstr Surg Glob Open 2017;5(07):e1407 https://doi.org/10.1097/GOX.0000000000001407
  19. Kim JYS, Qiu CS, Chiu WK, et al. A quantitative analysis of animation deformity in prosthetic breast reconstruction. Plast Reconstr Surg 2019;144(02):291-301 https://doi.org/10.1097/PRS.0000000000005800
  20. Dyrberg DL, Bille C, Koudahl V, Gerke O, Sorensen JA, Thomsen JB. Evaluation of breast animation deformity following pre- and subpectoral direct-to-implant breast reconstruction: a randomized controlled trial. Arch Plast Surg 2022;49(05):587-595 https://doi.org/10.1055/s-0042-1756337
  21. Dyrberg DL, Gunnarsson GL, Bille C, Sorensen JA, Thomsen JB. Direct-to-implant extracellular matrix hammock-based breast reconstruction; prepectoral or subpectoral? Trials 2020;21(01):160 https://doi.org/10.1186/s13063-020-4125-6
  22. Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg 1976;3(02):193-203 https://doi.org/10.1016/S0094-1298(20)30220-0
  23. Dyrberg DL, Bille C, Gunnarsson GL, Sorensen JA, Thomsen JB. Visualized pre- and subpectoral implant placement for immediate breast reconstruction. Gland Surg 2019;8(Suppl 4):S251-S254 https://doi.org/10.21037/gs.2019.05.09
  24. Willert CB, Gjorup CA, Holmich LR. Danish translation and linguistic validation of the BREAST-Q. Dan Med J 2020;67(05):A08190445
  25. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(02):377-381 https://doi.org/10.1016/j.jbi.2008.08.010
  26. Manrique OJ, Kapoor T, Banuelos J, et al. Single-stage direct-to-implant breast reconstruction: a comparison between subpectoral versus prepectoral implant placement. Ann Plast Surg 2020;84(04):361-365 https://doi.org/10.1097/SAP.0000000000002028
  27. Li L, Su Y, Xiu B, et al. Comparison of prepectoral and subpectoral breast reconstruction after mastectomies: a systematic review and meta-analysis. Eur J Surg Oncol 2019;45(09):1542-1550 https://doi.org/10.1016/j.ejso.2019.05.015
  28. Baker BG, Irri R, MacCallum V, Chattopadhyay R, Murphy J, Harvey JR. A prospective comparison of short-term outcomes of subpectoral and prepectoral strattice-based immediate breast reconstruction. Plast Reconstr Surg 2018;141(05):1077-1084 https://doi.org/10.1097/PRS.0000000000004270
  29. Walia GS, Aston J, Bello R, et al. Prepectoral versus subpectoral tissue expander placement: a clinical and quality of life outcomes study. Plast Reconstr Surg Glob Open 2018;6(04):e1731 https://doi.org/10.1097/GOX.0000000000001731
  30. Ng EI, Quah GS, Graham S, et al. Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction. ANZ J Surg 2021;91(04):701-707 https://doi.org/10.1111/ans.16670
  31. Ching AH, Lim K, Sze PW, Ooi A. Quality of life, pain of prepectoral and subpectoral implant-based breast reconstruction with a discussion on cost: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022;75(08):2550-2560 https://doi.org/10.1016/j.bjps.2022.02.019
  32. Neto MS, de Aguiar Menezes MV, Moreira JR, Garcia EB, Abla LEF, Ferreira LM. Sexuality after breast reconstruction post mastectomy. Aesthetic Plast Surg 2013;37(03):643-647 https://doi.org/10.1007/s00266-013-0082-8
  33. Hammond DC, Schmitt WP, O'Connor EA. Treatment of breast animation deformity in implant-based reconstruction with pocket change to the subcutaneous position. Plast Reconstr Surg 2015;135(06):1540-1544 https://doi.org/10.1097/PRS.0000000000001277