Long-term evaluation of postmastectomy breast reconstruction

Figures & data

Figure 1. Three methods of breast reconstruction. A. with a submuscular implant. B. with a latissimus dorsi flap (LD flap). C. with a pedicled transvers rectus musculocutaneous flap (TRAM flap). Courtesy Department of Clinical Photo, Aarhus University Hospital, Denmark.

Figure 2. Flowchart of the different breast reconstructive procedures evaluated in the study.

Figure 3. Postmastectomy breast reconstruction and common complications. A is reconstructions with implants. A2-3. Capsular contracture and loss of symmetry. B. Reconstructions with the LD flap. B2-3. Inferior color and size match. C. Reconstructions with the TRAM flap. C2-3. Insufficient skin color match and retraction after necrosis. Courtesy Department of Clinical Photo, Aarhus University Hospital, Denmark.

Table I. Patient demographics for women reconstructed with an implant, an LD flap or a TRAM flap at the time of reconstruction.

	Implant			LD flap			TRAM flap
Reconstructive procedure Women Included	Chart review	Questionnaire	Follow-up	Chart review	Questionnaire	Follow-up	Chart review	Questionnaire	Follow-up
Patient number	206	137	85	34	26	17	123	100	78
Age>50 at reconstruction	121 (59%)	85 (62%)	38 (45%)	21 (62%)	13 (50%)	10 (59%)	68 (55%)	55 (55%)	40 (51%)
BMI≤25	125 (61%)	88 (64%)	54 (64%)	24 (71%)	18 (69%)	13 (76%)	56 (46%)	47 (47%)	38 (49%)
BMI>25	53 (26%)	41 (30%)	25 (29%)	8 (24%)	8 (31%)	4 (24%)	57 (46%)	44 (44%)	33 (42%)
Active smokers	72 (35%)	49 (36%)	27 (32%)	12 (35%)	8 (31%)	6 (35%)	18 (15%)	13 (13%)	7 (9%)
Radiation therapy	51 (25%)	30 (22%)	23 (27%)	22 (65%)	19 (73%)	13 (76%)	65 (53%)	50 (50%)	42 (54%)
> 7 years since reconstruction	120 (58%)	78 (57%)	51 (60%)	15 (44%)	10 (38%)	7 (41%)	52 (42%)	56 (56%)	31 (40%)
Minor complications	56 (27%)	38 (28%)	27 (32%)	7 (21%)	6 (23%)	2 (12%)	43 (35%)	33 (33%)	23 (29%)
Major complications	26 (13%)	16 (12%)	16 (14%)	–	–	–	12 (13%)	10 (10%)	7 (9%)

The column displays numbers from the chart review for each subgroup. Of the 363 women included in the study (n), 263 women answered the questionnaire and 180 women participated in the follow-up visit. The women could have more than one complication.

Table II. Data from questionnaire.

Reconstructive procedure	Implant n= 137	LD flap n = 26	TRAM flap n=100	P-value
Overall satisfaction	88 (64%)	22 (81%)	84 (84%)	0.002
	52	14	66	0.004
Expectations fulfilled	87 (64%)	22 (81%)	84 (84%)	0.001
	52	14	66	0.002
Feeling feminine	101 (74%)	22 (81%)	88 (88%)	0.020
	62	13	71	0.010
Pleased with breast size	69 (50%)	14 (54%)	80 (80%)	< 0.0001
compared to the opposite breast	40	8	62	< 0.0001
Pleased with breast shape	49 (36%)	17 (65%)	77 (77%)	< 0.0001
	30	9	59	< 0.0001
Pleased with how the	56 (41%)	20 (77%)	94 (94%)	< 0.0001
breast feels	36	13	75	< 0.0001
Pleased with the scar on	87 (63%)	19 (73%)	78 (88%)	0.054
breast	49	13	61	0.037
Improved quality of life	114 (83%)	23 (88%)	90 (90%)	0.149
	72	14	70	0.217
Changed my way of	71(52%)	11 (42%)	46 (46%)	0.620
clothing	43	6	34	0.349
Increase in public bathing	51 (37%)	8 (31%)	40 (40%)	0.738
	31	4	32	0.389
Good overall health	94 (69%)	21 (81%)	77 (77%)	0.348
	60	14	57	0.746
Unchanged amount of	114 (83%)	21 (81%)	83 (83%)	0.969
physical activity	72	13	64	0.392

Questionnaire reported answers were dichotomized with the positive answers in the above table. The value in italic is the answer for the participants in the follow-up visit.

Table III. Data from follow-up visit.

Reconstructive procedure	Implant n = 85	LD flap n=17	TRAM flap n = 78	P-value
Overall a good result	37 (44%)	12 (71%)	66 (85%)	<0.0001
Good symmetry	22 (26%)	12 (71%)	50 (64%)	<0.0001
Can get up from a supine position without using hands	49 (58%)	12 (71%)	40 (51%)	0.308
Can perform sit-ups	70 (82%)	13 (76%)	59 (75%)	0.508
Severe visibility of scar	15 (18%)	1 (6%)	11 (14%)	0.486
Good sensitivity to touch	60 (71%)	9 (53%)	23 (29%)	<0.0001
Pigmentation changes	3 (13%*)	6 (46%*)	21 (50%*)	0.039
Telangiectasia	10 (44%*)	8 (62%*)	29 (69%*)	0.385
Fibrosis	7 (30%*)	3 (23%*)	20 (48%*)	0.468
Overall a good result at the donor site	–	11 (65%)	57 (69%)	0.773

A total of 180 women participated in the follow-up visit.

The ‘indicates percent based on the number of women previously treated with

Table IV. Complications after the first reconstructive procedure from the patient chart.

Reconstructive procedure	Implant n = 206	LD flap n = 34	TRAM flap n=123
Clinical infection	21 (10%)	4 (12%)	7 (6%)
Partial skin loss/clinical fat necrosis	7 (3%)	4 (12%)	42 (34%)
Seroma, evacuated	–	–	1 (1%)
Prolonged wound healing	3 (2%)	2 (6%)	22 (18%)
Necrosis	4 (2%)	–	10 (8%)
Hematoma (surgical evacuated)	–	–	2 (2%)
Skin perforation/
Implant rupture/
Implant loss	15 (7%)	–	–
Asymmetry/
Displacement	18 (9%)	–	–
Baker III, IV	10* (5%)	–	–
Donor site bulge/hernia	–	–	10 (8%)
Hypertrofic scarring	1 (1%)	1 (3%)	3 (2%)
Pain > 3 month	3 (2%)	–	4 (3%)

The women may have more than one complication. ‘Additional 11 women were registered in the charts as having capsular formation but with unknown Baker classification.