Unilateral breast reconstruction after mastectomy - patient satisfaction, aesthetic outcome and quality of life.

BACKGROUND: An increasing number of women undergo a breast reconstruction (BR) after treatment for breast cancer. The aim of the present study was to evaluate patient-reported esthetic satisfaction, quality of life (QoL), and the association between these, following different types of BR. MATERIALS AND METHODS: All women who underwent unilateral BR in Central Denmark Region between January 2005 and July 2011 were included. Participants were sent a questionnaire package, which included the Body Image Scale, The Beck Depression Inventory, the Impact of Event Scale, and a study-specific patient-reported esthetic satisfaction scale. Additionally, patients were asked if they experienced a change in QoL owing to the BR. Based on reconstructive method and timing, participants were divided into four groups, three delayed: an abdominal flap group, a latissimus dorsi flap group, an implant ± thoracodorsal flap group; and one immediate BR group. RESULTS: Of 166 eligible participants, a total of 144 women (87%) completed the questionnaire. The mean follow-up was 3.8 years. Esthetic satisfaction differed significantly between groups [F(3,139) = 8.55; p < 0.001], with abdominal flap recipients reporting the highest levels of esthetic satisfaction. No between-group differences were observed for the remaining psychosocial measures. Higher satisfaction with esthetic outcome was associated with reporting higher QoL owing to the BR (odds ratio 1.10, p<0.001; 95% CI 1.06-1.15). CONCLUSIONS: Abdominal flap recipients expressed higher satisfaction with their esthetic outcome, compared to the remaining BR types. Higher esthetic satisfaction was strongly associated with reporting an experience of higher QoL.

Fat grafting for alleviating persistent pain after breast cancer treatment: A randomized controlled trial.

BACKGROUND: Persistent pain is a common side effect of breast cancer treatment, affecting 24-52% of women after mastectomy. Recent studies have described analgesic effects of fat grafting in various settings. We aimed to investigate whether fat grafting had an analgesic effect on persistent pain after mastectomy and whether fat grafting had a remodeling effect on the mastectomy scar. METHODS: This study was conducted as a randomized controlled trial. Patients were randomized to either receive fat grafting to the pain-afflicted area around the missing breast or a control group without any intervention. A total of 18 unilaterally mastectomized women with persistent pain ≥3 on the numerical rating scale were enrolled. Patients were examined at the baseline and at 3 and 6 months by using the DoloTest(®), visual analog scale (VAS) pain score, neuropathic pain symptom inventory, and patient and observer scar assessment scale. RESULTS: A total of 15 patients were analyzed (fat grafted n = 8, control n = 7). The average amount of grafted fat was 71 ± 24.6 mL. Fat grafting showed a significant improvement in the pain as measured on the VAS pain scale (p = 0.001) with an average reduction of 54.9% and as measured on the neuropathic pain symptom inventory (p = 0.002). Furthermore, a significant improvement was observed in health-related quality of life (p = 0.007) and the quality of the scar (p < 0.001). CONCLUSION: This is the first randomized controlled trial evaluating the analgesic effect of fat grafting. Fat grafting is a safe and effective technique for alleviating persistent pain after mastectomy.