Background: Direct-to-implant (DTI) and tissue expander/implant (TE/I) reconstructions are the most common implant-based reconstructions after nipple-sparing mastectomy (NSM). However, there are little data beyond complication rates comparing these options. Fat grafting has emerged as an adjunct in NSM reconstructions to improve aesthetic results; however, its impact on patient perceptions of aesthetic outcomes remain unknown. To improve patient-centered care, aesthetic outcomes must be considered from the patients' perspective. Objectives: To evaluate patient-reported outcomes of aesthetic satisfaction and quality of life in patients undergoing immediate DTI vs TE/I reconstruction after NSM and to assess the role of fat grafting on these outcomes. Methods: This is a prospective cohort study comparing NSM patients undergoing DTI or TE/I reconstruction. Patient-reported outcomes were evaluated using the BREAST-Q. Continuous and categorical variables were analyzed using t test and Fisher's exact test, respectively. Results: Fifty-nine patients underwent 113 reconstructions with either DTI (n = 41) or TE/I (n = 18). Mean follow up was 12.1 months. DTI and TE/I patients had comparable satisfaction with outcome, though TE/I patients had significantly larger final implant sizes. TE/I who underwent fat grafting also had significantly higher satisfaction with outcome and psychosocial wellbeing. Conclusions: Patient-reported outcomes are comparable between DTI and TE/I reconstructions after NSM. In order for TE/I patients to achieve a similar level of satisfaction, they may require a larger final implant and additional operations compared to DTI patients. Additionally, fat grafting improves overall satisfaction. TE/I patients may have different aesthetic expectations than DTI patients, emphasizing patient-centered discussions are essential to optimizing outcomes after NSM. Level of Evidence: 3.
Background: Direct-to-implant (DTI) and tissue expander/implant (TE/I) reconstructions are the most common implant-based reconstructions after nipple-sparing mastectomy (NSM). However, there are little data beyond complication rates comparing these options. Fat grafting has emerged as an adjunct in NSM reconstructions to improve aesthetic results; however, its impact on patient perceptions of aesthetic outcomes remain unknown. To improve patient-centered care, aesthetic outcomes must be considered from the patients' perspective. Objectives: To evaluate patient-reported outcomes of aesthetic satisfaction and quality of life in patients undergoing immediate DTI vs TE/I reconstruction after NSM and to assess the role of fat grafting on these outcomes. Methods: This is a prospective cohort study comparing NSM patients undergoing DTI or TE/I reconstruction. Patient-reported outcomes were evaluated using the BREAST-Q. Continuous and categorical variables were analyzed using t test and Fisher's exact test, respectively. Results: Fifty-nine patients underwent 113 reconstructions with either DTI (n = 41) or TE/I (n = 18). Mean follow up was 12.1 months. DTI and TE/I patients had comparable satisfaction with outcome, though TE/I patients had significantly larger final implant sizes. TE/I who underwent fat grafting also had significantly higher satisfaction with outcome and psychosocial wellbeing. Conclusions: Patient-reported outcomes are comparable between DTI and TE/I reconstructions after NSM. In order for TE/I patients to achieve a similar level of satisfaction, they may require a larger final implant and additional operations compared to DTIpatients. Additionally, fat grafting improves overall satisfaction. TE/I patients may have different aesthetic expectations than DTIpatients, emphasizing patient-centered discussions are essential to optimizing outcomes after NSM. Level of Evidence: 3.
Authors: Elizabeth B Odom; Rajiv P Parikh; Grace Um; Simone W Kantola; Amy E Cyr; Julie A Margenthaler; Marissa M Tenenbaum; Terence M Myckatyn Journal: Plast Reconstr Surg Date: 2018-07 Impact factor: 4.730
Authors: Matthew J Davis; Aurelia T Perdanasari; Amjed Abu-Ghname; Santiago R Gonzalez; Edward Chamata; Charalambos K Rammos; Sebastian J Winocour Journal: Semin Plast Surg Date: 2020-02-15 Impact factor: 2.314
Authors: Oscar J Manrique; Joseph Banuelos; Amjed Abu-Ghname; Minh-Doan Nguyen; Nho V Tran; Jorys Martinez-Jorge; Christin Harless; Basel Sharaf; James W Jakub; Amy C Degnim; Judy C Boughey; Steven R Jacobson Journal: Plast Reconstr Surg Glob Open Date: 2019-03-13
Authors: Walter P Weber; Martin Haug; Christian Kurzeder; Vesna Bjelic-Radisic; Rupert Koller; Roland Reitsamer; Florian Fitzal; Jorge Biazus; Fabricio Brenelli; Cicero Urban; Régis Resende Paulinelli; Jens-Uwe Blohmer; Jörg Heil; Jürgen Hoffmann; Zoltan Matrai; Giuseppe Catanuto; Viviana Galimberti; Oreste Gentilini; Mitchel Barry; Tal Hadar; Tanir M Allweis; Oded Olsha; Maria João Cardoso; Pedro F Gouveia; Isabel T Rubio; Jana de Boniface; Tor Svensjö; Susanne Bucher; Peter Dubsky; Jian Farhadi; Mathias K Fehr; Ilario Fulco; Ursula Ganz-Blättler; Andreas Günthert; Yves Harder; Nik Hauser; Elisabeth A Kappos; Michael Knauer; Julia Landin; Robert Mechera; Francesco Meani; Giacomo Montagna; Mathilde Ritter; Ramon Saccilotto; Fabienne D Schwab; Daniel Steffens; Christoph Tausch; Jasmin Zeindler; Savas D Soysal; Visnu Lohsiriwat; Tibor Kovacs; Anne Tansley; Lynda Wyld; Laszlo Romics; Mahmoud El-Tamer; Andrea L Pusic; Virgilio Sacchini; Michael Gnant Journal: Breast Cancer Res Treat Date: 2018-09-04 Impact factor: 4.872