A multi centre prospective longitudinal study evaluating health related quality of life after immediate Latissimus dorsi (LD) breast reconstruction

Introduction: NICE recommends that the majority of women should be offered immediate breast reconstruction with its potential to improve health related quality of life (HRQL). There is conflicting evidence with a lack of ‘hard’data to best inform clinicians and their patients. Our aim was to evaluate the effects of implant-assisted LD (LDI) versus autologous LD (ALD) breast reconstruction on HRQL over 12 months. Methods: A prospective longitudinal multicentre study commenced in early 2007. Patient reported outcome measures using the EORTC C30 (general HRQL), BR-23 (breast + arm symptoms), Body Image Scale (BIS) and HADS, were completed pre-operatively and at 3, and 12 months after surgery. Longitudinal analyses tested the effects of treatment variables, baseline HRQL, age and time on QL domains (3–12 months). Significance was set at p = 0.01. Results: One hundred and seventy one patients (93 ALD, 78 LDI) were recruited. There were no significant differences in HRQL domains between LDI and ALD (±RT). Chemotherapy patients reported poorer overall HRQL (p < 0.001), poorer role (p = 0.003) and social (p = 0.01) functioning, and greater fatigue (p = 0.002) and depression (p = 0.01). Older patients had fewer HRQL issues (p = 0.01). Significant improvements over time were seen for overall HRQL and other domains (p < 0.001). There were no significant differences between LDI and ALD for patient satisfaction with surgical outcome. Good satisfaction with overall breast appearance and surgical outcome was significantly associated with fewer body image concerns. Conclusion: There is an important need for cumulative clinical evidence in this field on which to base patient informed consent and clinical recommendations