Donald W Buck1, Deana Shenaq, Kamaldeep Heyer, Caroline Kato, John Y S Kim. 1. Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North St Clair Street, Galter Suite 19-250, Chicago, IL 60611, United States.
Abstract
INTRODUCTION: Tissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. The evolution of patient satisfaction throughout this process has not been evaluated. Here we performed a stratified analysis of patient-subjective cosmetic outcomes during the stages of breast reconstruction. METHODS: Twenty-eight consecutive tissue expander-implant reconstructions were performed by the senior author using human acellular dermis. Cosmetic outcomes were assessed after each reconstructive stage using a validated Breast Evaluation Questionnaire consisting of questions related to breast size, shape and firmness in three separate contexts: intimate or sexual activities, leisure or social activities, and professional or job-related activities. RESULTS: Eighteen patients underwent unilateral reconstruction, while 10 underwent bilateral reconstruction. Satisfaction scores were statistically higher following Stage I and II procedures for bilateral reconstructions. For unilateral reconstructions, there was a statistically significant elevation in scores following Stage II. The addition of nipple-areola reconstruction resulted in the highest scores for both unilateral and bilateral reconstructions. These score elevations were significant (p < 0.05) in nearly every measured context for unilateral reconstructions and as such, the significant differences in scores between unilateral and bilateral cohorts after stages I and II were nearly eliminated after completion of the entire reconstructive process. CONCLUSION: Satisfaction with tissue expander reconstruction is significantly affected by the patients' stage during the reconstructive process. Completion of all three stages, including nipple-areolar complex reconstruction, achieves maximal patient satisfaction. For unilateral reconstructions, completion of the entire reconstructive process, including contralateral symmetry procedures and nipple-areolar complex reconstruction, results in cosmesis scores that are similar to those in bilateral cases.
INTRODUCTION: Tissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. The evolution of patient satisfaction throughout this process has not been evaluated. Here we performed a stratified analysis of patient-subjective cosmetic outcomes during the stages of breast reconstruction. METHODS: Twenty-eight consecutive tissue expander-implant reconstructions were performed by the senior author using human acellular dermis. Cosmetic outcomes were assessed after each reconstructive stage using a validated Breast Evaluation Questionnaire consisting of questions related to breast size, shape and firmness in three separate contexts: intimate or sexual activities, leisure or social activities, and professional or job-related activities. RESULTS: Eighteen patients underwent unilateral reconstruction, while 10 underwent bilateral reconstruction. Satisfaction scores were statistically higher following Stage I and II procedures for bilateral reconstructions. For unilateral reconstructions, there was a statistically significant elevation in scores following Stage II. The addition of nipple-areola reconstruction resulted in the highest scores for both unilateral and bilateral reconstructions. These score elevations were significant (p < 0.05) in nearly every measured context for unilateral reconstructions and as such, the significant differences in scores between unilateral and bilateral cohorts after stages I and II were nearly eliminated after completion of the entire reconstructive process. CONCLUSION: Satisfaction with tissue expander reconstruction is significantly affected by the patients' stage during the reconstructive process. Completion of all three stages, including nipple-areolar complex reconstruction, achieves maximal patient satisfaction. For unilateral reconstructions, completion of the entire reconstructive process, including contralateral symmetry procedures and nipple-areolar complex reconstruction, results in cosmesis scores that are similar to those in bilateral cases.
Authors: Jonas A Nelson; Sophocles H Voineskos; Ji Qi; Hyungjin M Kim; Jennifer B Hamill; Edwin G Wilkins; Andrea L Pusic Journal: Plast Reconstr Surg Date: 2019-12 Impact factor: 4.730
Authors: Juhun Lee; Si Chen; Gregory P Reece; Melissa A Crosby; Elisabeth K Beahm; Mia K Markey Journal: IEEE Trans Biomed Eng Date: 2012-01-16 Impact factor: 4.538
Authors: Michael Sorkin; Ji Qi; Hyungjin M Kim; Jennifer B Hamill; Jeffrey H Kozlow; Andrea L Pusic; Edwin G Wilkins Journal: Plast Reconstr Surg Date: 2017-12 Impact factor: 4.730
Authors: E Hope Weissler; Julie B Schnur; Andreas M Lamelas; Marisa Cornejo; Elan Horesh; Peter J Taub Journal: Ann Plast Surg Date: 2017-06 Impact factor: 1.539