Associations between Reoperations and Psychological Factors after Contralateral Risk-Reducing Mastectomy: A Two-Year Follow-Up Study

Introduction. The aim of the study was to investigate associations between reoperations after contralateral risk-reducing mastectomies (CRRM) and emotional problems, body image, sexuality, and health related quality of life (HRQoL) in women with breast cancer and hereditary high risk. Patients and Methods. Patients scheduled for CRRM with breast reconstruction between 1998 and 2010 completed questionnaires, comprised of SF-36, the Hospital Anxiety and Depression Scale, the Body Image Scale, and the Sexual Activity Questionnaire, preoperatively and two years after CRRM. Data on reoperations was collected from medical charts. Results. A total of 80 women participated, with a response rate of 61 (76%) preoperatively and 57 (71%) at the two-year followup. At the two-year assessment, 44 (55%) patients had undergone ≥1 reoperation (reoperation group), whereas 36 (45%) had not (no reoperation group). No statistically significant differences between the groups were found for HRQoL, sexuality, anxiety, or depression. A higher proportion of patients in the "reoperation group" reported being dissatisfied with their bodies (81% versus 48%, = 0.01). Conclusion. The results suggest associations between reoperation following CRRM with breast reconstruction and body image problems. Special attention should be paid to body image problems among women who are subject to reoperations after CRRM

Different aspects of breast reconstruction : contralateral prophylactic mastectomy, postmastectomy radiotherapy, complications after biomaterials injection

The advances in breast reconstruction and oncoplastic surgery have positively affected the cosmetic and functional outcomes without compromising oncological safety. In this thesis, different aspects and challenges of reconstruction of the breast have been addressed. Specifically, reconstructive outcomes and quality of life after contralateral prophylactic mastectomy in women with a personal and family history of breast cancer, the role of implant reconstruction in postmastectomy radiotherapy, and the management of complications after polyacrylamide gel injections are discussed. In article I the clinical course of bilateral breast reconstruction and possible influence of adjuvant treatment were addressed in a consecutive series of patients with a personal and family history of breast cancer undergoing contralateral prophylactic mastectomy (CPM) during 1998-2008 (n=91). The findings indicated that CPM was a complex procedure, where the majority of patients (82%) received concurrent bilateral breast reconstruction. In addition, during the 3.9 years follow-up period more than half of the patients required at least one reconstruction-related operation. The clinical course after bilateral breast reconstruction was predominantly affected by operations on the cancer side, and reoperation was associated with radiotherapy. A protocol for management of patients opting for CPM and bilateral breast reconstruction is highly demanded. In article II the psychosocial outcomes of CPM with reconstruction in patients with a personal and family history of breast cancer were assessed. In this prospective questionnaire study no negative changes in health-related quality of life, sexuality or body image were found. At the 2-year postoperative assessment, the patients showed a satisfactory quality of life similar to women in general population. However, CPM could have a negative impact on the particular aspects of body image including dissatisfaction with the body, appearance, scars, femininity, and attractiveness. Women considering CPM should be informed about the possible psychosocial implications and outcomes of the operation. In article III the impact of immediate breast reconstruction with implants on dose distribution of radiotherapy was addressed in a cohort study of patients with (n=162) and without (n=558) breast implants. Overall, there was no difference in radiation doses to the organs at risk (ipsilateral lung and heart) between the two groups of patients. The presence of breast implants during radiotherapy planning was not associated with increased doses to ipsilateral lung and heart or decreased coverage of the target volume. Further studies specifically addressing consequences of radiotherapy with the longer follow-up will shed light on oncologic safety aspects. In article IV the results from a retrospective multicenter study from Ukraine on patients with complications after breast augmentation with polyacrylamide gel (n=106) were evaluated. The injections were found to have caused irreversible damage to the breast in previously healthy women as they presented with multiple symptoms as pain (80%), breast deformity (73%), lumps (54%), and gel migration (37%). All patients necessitated gel removal with complex debridement operations; 39% with partial mastectomy, 7% with subcutaneous mastectomy; and 72% required a subsequent breast reconstruction. Public awareness of the potential hazards associated with injectables is warranted

Cardiovascular complications secondary to Graves' disease: a prospective study from Ukraine.

Graves' disease (GD) is a common cause of hyperthyroidism resulting in development of thyrotoxic heart disease (THD).to assess cardiovascular disorders and health related quality of life (HRQoL) in patients with THD secondary to GD.All patients diagnosed with THD secondary to GD between January 2011 and December 2013 were eligible for this study. Clinical assessment was performed at baseline and at the follow-up visit after the restoring of euthyroid state. HRQoL was studied with a questionnaire EQ-5D-5L.Follow-up data were available for 61 patients, but only 30 patients with THD secondary to GD were consented to participate in investigation of their HRQoL. The frequency of cardiovascular complications was significantly reduced as compared before and after the antithyroid therapy as follows: resting heart rate (122 vs. 74 bpm), blood pressure: systolic (155 vs. 123 mm Hg), diastolic (83 vs. 66 mm Hg), supraventricular premature contractions (71% vs. 7%), atrial fibrillation (72% vs. 25%), congestive heart failure (69% vs. 20%), thyrotoxic cardiomyopathy (77% vs. 26%), all p<0.01. Anti-TSH receptor antibodies were determined as independent predictor of left ventricular geometry changes, (b-coefficient = 0.04, 95%CI 0.01-0.07, p = 0.02). HRQoL was improved in all domains and self-rated health increased from 43 to 75 units by visual analogue score (p<0.001).Restoring of euthyroid state in patients with GD is associated with significant elimination of cardiovascular disorders and improvement of HRQoL. To our knowledge this is the first study evaluating Ukrainian patients with THD secondary to GD with focus on HRQoL

Health related quality of life assessed by the EQ-5D-5L instrument.

<p>Health related quality of life assessed by the EQ-5D-5L instrument.</p

Medications for treatment of cardiological complications before the antithyroid therapy and after the follow-up.

<p>Medications for treatment of cardiological complications before the antithyroid therapy and after the follow-up.</p

Evaluation of cardiovascular complications secondary to Graves’ disease before and after the antithyroid therapy.

<p>Evaluation of cardiovascular complications secondary to Graves’ disease before and after the antithyroid therapy.</p

Clinical characteristics of the patients before and after the antithyroid therapy.

<p>* = missing in 6 cases</p><p>** = missing in 5 cases</p><p>Clinical characteristics of the patients before and after the antithyroid therapy.</p

Analyses of cardiovascular parameters before and after the antithyroid therapy in patients with Graves’ disease.

<p>Analyses of cardiovascular parameters before and after the antithyroid therapy in patients with Graves’ disease.</p

Illustration of HRQoL assessment by reported levels 1 to 5 for each dimension of the EQ-5D-5L instrument.

<p>Patients reported less problems after restoring of euthyroidism as compared to hyperthyroid state.</p

Graphical presentation of health status of patients by a Visual Analogue Scale (VAS).

<p>Box plots illustrating significantly lower self-rated health status of patients with hyperthyroidism (Before) as compared to euthyroid patients (After) by VAS scoring.</p