Patient-centered outcomes of breast reconstruction in the setting of post-mastectomy radiotherapy: A comprehensive review of the literature.

BACKGROUND: The impact of post-mastectomy radiotherapy (PMRT) on patient-centered outcomes of breast reconstruction remains unclear. This comprehensive review aims to consolidate the available data regarding aesthetic outcomes, patient satisfaction, and the BREAST-Q© following breast reconstruction in the setting of PMRT to facilitate the informed consent and shared decision-making process.
MATERIALS AND METHODS: A systematic search of the literature published from 2000 to 2016 in the PubMed/MEDLINE database was performed to identify all manuscripts reporting aesthetic outcome, patient satisfaction, or BREAST-Q© scores of patients undergoing PMRT and breast reconstruction.
RESULTS: The initial search identified 1604 potential titles. Ultimately, 29 manuscripts fit inclusion criteria and were included in this review. A total of 21 studies reported measures of aesthetic outcomes (1611 patients). Positive aesthetic outcomes ("good" or "better") widely varied in patients with prosthetic reconstruction and ranged from 36% to 100%. In addition, positive aesthetic outcomes following autologous reconstruction ranged from 70% to 90%. Measures of patient satisfaction were evaluated in eight studies (722 patients). Satisfaction rates ranged from 41% to 90% following prosthetic reconstruction and 74%-75% following autologous reconstruction. BREAST-Q© findings were reported in four studies (575 patients), all evaluating outcomes following prosthetic reconstruction. The range of satisfaction with breasts was 48.9-57.2; satisfaction with outcome, 63.8-70.2; psychosocial well-being, 63.9-72.3; sexual well-being, 45.4-55.4; and physical well-being, 71.7-75.1.
CONCLUSIONS: Breast reconstruction in the setting of PMRT is associated with poorer outcomes. However, the majority of studies indicate that acceptable rates of positive aesthetic outcomes and patient satisfaction can be achieved in the setting of PMRT.