Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors: A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods

Autor: Macadam, Sheina A., Zhong, Toni, Weichman, Katie, Papsdorf, Michael, Lennox, Peter A., Hazen, Alexes, Matros, Evan, Disa, Joseph, Mehrara, Babak, Pusic, Andrea L., Van Laeken, Nancy, Cordeiro, Peter, Vidal, Dale, Klassen, Anne, Cano, Stefan
Rok vydání: 2017
Předmět:
Graft Rejection
medicine.medical_specialty
medicine.medical_treatment
Mammaplasty
Rectus Abdominis
Breast Neoplasms
Risk Assessment
Transplantation
Autologous
Article
03 medical and health sciences
0302 clinical medicine
Breast cancer
Quality of life
Surveys and Questionnaires
Medicine
Humans
030212 general & internal medicine
Survivors
Mastectomy
Aged
Analysis of Variance
Chi-Square Distribution
business.industry
Graft Survival
Middle Aged
medicine.disease
Epigastric Arteries
Myocutaneous Flap
United States
Surgery
Transplantation
Patient Outcome Assessment
medicine.anatomical_structure
Cross-Sectional Studies
Logistic Models
Treatment Outcome
030220 oncology & carcinogenesis
Quality of Life
Abdomen
Female
Self Report
business
Breast reconstruction
Chi-squared distribution
Perforator Flap
Follow-Up Studies
Zdroj: Plastic and reconstructive surgery. 137(3)
ISSN: 1529-4242
Popis: Approximately 20 percent of women select autologous tissue for postmastectomy breast reconstruction, and most commonly choose the abdomen as the donor site. An increasing proportion of women are seeking muscle-sparing procedures, but the benefit remains controversial. It is therefore important to determine whether better outcomes are associated with these techniques, thereby justifying longer operative times and increased costs.Patients from five North American centers were eligible if they underwent reconstruction by means of the deep inferior epigastric artery perforator (DIEP) flap, muscle-sparing free transverse abdominis myocutaneous (TRAM) flap, free TRAM flap, or the pedicled TRAM flap. Patients were sent the BREAST-Q. Demographics and complications were collected.The authors analyzed 1790 charts representing 670 DIEP, 293 muscle-sparing free TRAM, 683 pedicled TRAM, and 144 free TRAM patients with an average follow-up of 5.5 years. Flap loss did not differ by flap type. Partial flap loss was higher in pedicled TRAM compared with DIEP (p = 0.002). Fat necrosis was higher in pedicled TRAM compared with DIEP and muscle-sparing free TRAM (p0.001). Hernia/bulge was highest in pedicled TRAM (p0.001). Physical well-being (abdomen) scores were higher in DIEP compared with pedicled TRAM controlling for confounders.Complications and patient-reported outcomes differ when comparing abdominally based breast reconstruction techniques. The results of this study show that the DIEP flap was associated with the highest abdominal well-being and the lowest abdominal morbidity compared with the pedicled TRAM flap, but did not differ from muscle-sparing free TRAM and free TRAM flaps.Therapeutic, III.
Databáze: OpenAIRE
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