Patient satisfaction with aesthetic outcome after bilateral prophylactic mastectomy and immediate reconstruction with implants

https://doi.org/10.1016/j.bjps.2008.11.014Get rights and content

Summary

Previous studies regarding body image after bilateral prophylactic mastectomy with breast reconstruction have reported a risk of reduced satisfaction with body image and adverse effects on sexual life. The aim of this retrospective study was to find areas for future surgical improvements to optimize patient satisfaction with the aesthetic result after bilateral prophylactic mastectomy and immediate breast reconstruction with implants. Nipple-areola complexes were reconstructed. Twenty-four consecutive and standardized operated women were included. The follow-up time was an average of 5.4 (range: 2.4–10.2) years.

The outcome in terms of breast symmetry, size, and firmness were measured with objective and subjective methods, and results were compared to those from a control group of 24 women. Patient satisfaction was evaluated with a questionnaire.

Main findings were that the overall aesthetic result was regarded as good in both objective and subjective evaluations and that breast symmetry in patients was as common as in the control group, but reconstructed breasts were firmer. Twenty of 24 patients thought that the aesthetic result exceeded their expectations, and 22/24 would recommend this kind of breast reconstruction to another woman. In contrast with the predictions of plastic surgeons, patients were most dissatisfied with the nipple-areola reconstruction.

Conclusions

The overall aesthetic result after bilateral prophylactic mastectomy and immediate breast reconstruction with implants was good and symmetrical. Patient satisfaction with nipple-areola reconstruction was only moderate. The results emphasize the importance of a preoperative discussion with the patient regarding whether to keep or reconstruct the nipple-areola complex while planning a prophylactic mastectomy.

Section snippets

Materials

The purpose of this study was to evaluate the cosmetic outcome in a specific group of patients without a previous history of breast cancer who underwent bilateral prophylactic mastectomy and immediate breast reconstruction with implants. To be able to evaluate the final aesthetic result, patients who had undergone their last breast surgical procedure fewer than two years prior were excluded. Twenty-eight consecutive patients operated upon with bilateral prophylactic mastectomy and immediate

Breast symmetry

To evaluate symmetry between the right and the left breast, the positions of the nipple and submammary fold were calculated. This was done by measuring the distance between the jugulum and the nipple, the midline and the nipple, and the jugulum and the submammary fold on both sides with the patient in an upright position.17

Breast volume

The volume of the breast was estimated using a thermoplastic cast system, ORFIT®, which made a cast from each breast with the patient in an upright position. The cast was

Breast symmetry

The mean values and ranges of the distances are presented in Table 1. The calculated symmetry ratios between the right and left breasts did not differ significantly between patients and controls.

Breast volume

Breast sizes in patients and controls are presented in Table 1. There was no difference in the mean breast volume between the right and left breasts (volume symmetry) between patients and controls, and the mean breast volume did not differ significantly between the right and left breasts either within

Discussion

When a woman with a high risk of developing breast cancer seeks counseling about prophylactic mastectomy and breast reconstruction, she needs to receive extensive evidence-based information about the possible consequences of the surgery.12, 15 This is of specific importance since the surgical procedure is prophylactic and thus not mandatory. Perceived lack of information strongly correlates with less postoperative satisfaction. Since dissatisfaction with aesthetic outcome can produce negative

Acknowledgements

This research is supported by grants from the Percy Falk Foundation, Dagmar Ferb Foundation, Emma and Erik Granes Memorial, and Capio Research Foundation. The study sponsors were not involved in the research or process of this manuscript.

We thank Tina Björklund, RN for her supportive help in contacting patients and Bo Nilsson, BSc in Statistics for excellent assistance with the statistical analysis and some of the figures. We also thank all patients participating in this study.

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