Outcome of Quality of Life for Women Undergoing Autologous versus Alloplastic Breast Reconstruction following Mastectomy:A Systematic Review and Meta-Analysis

Background: This review aimed to meta-analyze the quality of life of alloplastic versus autologous breast reconstruction, when measured with the BREAST-Q. Methods: An electronic PubMed and EMBASE search was designed to find articles that compared alloplastic versus autologous breast reconstruction using the BREAST-Q. Studies that failed to present BREAST-Q scores and studies that did not compare alloplastic versus autologous breast reconstruction were excluded. Two authors independently extracted data from the included studies. A standardized data collection form was used. Quality was assessed using the Newcastle-Ottawa Scale. The mean difference and 95 percent confidence intervals between breast reconstruction means were estimated for each BREAST-Q subscale. Forest plots and the I2statistic were used to assess heterogeneity and funnel plot publication bias. The Z test was used to assess overall effects. Results: Two hundred eighty abstracts were found; 10 articles were included. Autologous breast reconstruction scored significantly higher in the five subscales than alloplastic breast reconstruction. The Satisfaction with Breasts subscale indicated the greatest difference, with a mean difference of 6.41 (95 percent CI, 3.58 to 9.24; I2= 70 percent). The Satisfaction with Results subscale displayed a mean difference of 5.52. The Sexual Well-Being subscale displayed a mean difference of 3.85. The Psychosocial Well-Being subscale displayed a mean difference of 2.64. The overall difference in physical well-being was significant, with high heterogeneity (mean difference, 3.33; 95 percent CI, 0.18 to 6.48; I2= 85). Conclusion: Autologous breast reconstruction had superior outcomes compared with alloplastic breast reconstruction as measured by the BREAST-Q

Short-term Quality of Life after Autologous Compared to Alloplastic Breast Reconstruction:A Prospective Study

BACKGROUND: The aim of this prospective multi-center study was to evaluate whether autologous breast reconstruction (BR) leads to lower short-term Quality of Life (QoL) compared to alloplastic BR, due the more physically demanding surgery and increased risk of severe complications of autologous BR.METHODS: Changes in QoL following BR were measured in this prospective multi-center study using the Breast-Q questionnaire which was administered preoperatively, and at six weeks and six months postoperatively. Characteristics and complications, classified according to Clavien-Dindo (CD), were compared between alloplastic and autologous groups. Profile plots and generalized Linear regression models were constructed to analyze the Breast-Q subscales over time for both BR groups.RESULTS: Preoperatively, women undergoing autologous BR scored lower on all Breast-Q scales compared to women undergoing alloplastic BR, regardless whether they underwent immediate or delayed BR. Women undergoing autologous BR scored higher at six weeks and six months postoperative on "satisfaction with breasts" (p=0.001), "psychosocial well-being" (p=0.024) and "sexual well-being" (p=0.007). Postoperative "physical well-being: chest" was similar between both groups (p=0.533). CD grade ≥III complications occurred more often among women in the autologous group (27% versus 12%, p=0.042). Complications were not associated with worse Breast-Q scores on any of the subscales.CONCLUSION: In contrast to our expectations and despite the higher incidence of severe complications and lower preoperative breast satisfaction and QoL scores, women undergoing autologous BR have higher levels of breast satisfaction, and psychosocial and sexual well-being, both at six weeks and six months after BR compared to women undergoing alloplastic BR.</p

Short-term Quality of Life after Autologous Compared to Alloplastic Breast Reconstruction:A Prospective Study

BACKGROUND: The aim of this prospective multi-center study was to evaluate whether autologous breast reconstruction (BR) leads to lower short-term Quality of Life (QoL) compared to alloplastic BR, due the more physically demanding surgery and increased risk of severe complications of autologous BR.METHODS: Changes in QoL following BR were measured in this prospective multi-center study using the Breast-Q questionnaire which was administered preoperatively, and at six weeks and six months postoperatively. Characteristics and complications, classified according to Clavien-Dindo (CD), were compared between alloplastic and autologous groups. Profile plots and generalized Linear regression models were constructed to analyze the Breast-Q subscales over time for both BR groups.RESULTS: Preoperatively, women undergoing autologous BR scored lower on all Breast-Q scales compared to women undergoing alloplastic BR, regardless whether they underwent immediate or delayed BR. Women undergoing autologous BR scored higher at six weeks and six months postoperative on "satisfaction with breasts" (p=0.001), "psychosocial well-being" (p=0.024) and "sexual well-being" (p=0.007). Postoperative "physical well-being: chest" was similar between both groups (p=0.533). CD grade ≥III complications occurred more often among women in the autologous group (27% versus 12%, p=0.042). Complications were not associated with worse Breast-Q scores on any of the subscales.CONCLUSION: In contrast to our expectations and despite the higher incidence of severe complications and lower preoperative breast satisfaction and QoL scores, women undergoing autologous BR have higher levels of breast satisfaction, and psychosocial and sexual well-being, both at six weeks and six months after BR compared to women undergoing alloplastic BR.</p

Decisional conflict in breast cancer patients considering immediate breast reconstruction

Background: Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC). Methods: Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision aid for BC patients considering immediate breast reconstruction after mastectomy were analyzed. Participants completed questionnaires assessing sociodemographic and clinical characteristics, decisional conflict and other patient-reported outcomes related to decision-making such as breast reconstruction preference, knowledge, information resources used, preferred involvement in decision-making, information coping style, and anxiety. Multivariable logistic regression analysis was performed to identify factors associated with CSDC (score > 37.5 on decisional conflict). Results: Of the 250 participants, 68% experienced CSDC. Patients with a slight preference for breast reconstruction (odds ratio (OR) = 6.19, p < .01), with no preference for or against breast reconstruction (OR = 11.84, p < .01), and with a strong preference for no breast reconstruction (OR = 5.20, p < .05) were more likely to experience CSDC than patients with a strong preference for breast reconstruction. Furthermore, patients with more anxiety were more likely to experience CSDC (OR = 1.03, p = .01). Conclusion: A majority of BC patients who consider immediate breast reconstruction after mastectomy experience clinically significant decisional conflict. The findings emphasize the need for decision support, especially for patients who do not have a strong preference for breast reconstruction

Decisional conflict in breast cancer patients considering immediate breast reconstruction

Background: Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC). Methods: Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision

Bipolar coagulation-assisted orbital (BICO) septoblepharoplasty - A retrospective anolysis of a new fot-soving upper-eyelid blephoroplosty technique

Background: Upper eyelid blepharoplasty generally is performed as a combination of excess skin reduction and fat resection. Fat resection can in the long term result in a hollow orbit. Therefore, treatment of the lax orbital septum, in combination with skin reduction, seems a more preferable approach than fat resection. The authors describe a technique of upper-eyelid blepharoplasty: a combination of excess skin reduction and shortening of the stretched lax orbital septum by means of bipolar coagulation. This procedure is called bipolar coagulation-assisted orbital septoblepharoplasty, ie, BICO septoblepharoplasty. The aim of this retrospective study is to report on our initial experience with this technique. Methods: We retrospectively analyzed 296 patients in whom an upper-eyelid blepharoplasty was performed during the past 4 years using the BICO septoblepharoplasty technique: first, excess skin is removed, then a small rim of orbicularis muscle is excised to expose the bulging orbital septum, and finally, before closure of the wound, bipolar coagulation of the exposed orbital septum is performed. This results in shrinkage of the septum and thus in repositioning of the pseudoherniated fat pads. Results: At discharge from follow-up, which varied from 9 weeks (72% of the patients) up till 2 years after surgery (28% of the patients), in all patients ultimately a satisfactory result was achieved and ultimately all were satisfied or very satisfied with the result of the procedure. There were only 3 patients with minor complications: I patient with a slightly retracting sear, which resolved spontaneously, and 2 patients with slight asymmetry requiring additional skin resection. Conclusions: BICO septoblepharoplasty of the upper eyelid seems to be an effective way to treat blepharochalasia of the upper eyelid; the bipolar coagulation of the orbital septum will lead to shrinkage of the septum, thereby repositioning the prolapsing medial and central fat pads. Secondary fibrosis will reinforce the orbital septurm postoperatively