PAST
The past decade has brought significant advancement to our understanding of patient-reported outcomes (PROs) in breast reconstruction. The BREAST-Q was introduced in 2009 and has since become one of the most commonly utilized metrics in the field.1 Large-scale studies, such as those from the Mastectomy Reconstruction Outcomes Consortium and from Memorial Sloan Kettering Cancer Center, have given us deeper understanding of PROs and indicated multiple factors influencing both satisfaction and quality of life, including modality of reconstruction (autologous favored over implant based) and radiation therapy (having a deleterious effect).2,3 Such studies have often utilized regression modeling to control for differences across the study populations.
PRESENT
The current study moves towards deeper understanding of patient satisfaction and quality of life by removing a critical variable from the breast reconstruction cohort: a history of radiation therapy.4 By removing this variable, which has a deleterious impact on reconstruction and well-being,3 we are able to dive closer to a true understanding of the reconstructive modality in patient satisfaction and well-being. Patients were then matched on a priori variables to create two groups with equal propensity to undergo either autologous or implant-based reconstruction.5 The results, though preliminary and underpowered, indicate that both modalities can provide patients with reasonable outcomes at 1 and 2 years, with no significant differences in satisfaction or physical well-being domains.
FUTURE
As patient-reported outcomes become more common-place in routine care, both breast reconstruction clinical decision-making and research will benefit. Appropriately powered future studies will help better understand patient satisfaction and health-related quality of life following autologous and implant-based reconstruction, both in patients not requiring radiation therapy and in those who do require radiation as part of their oncologic care.
FUNDING
This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
Footnotes
DISCLOSURES
Drs. Nelson and Allen report no competing interests.
REFERENCES
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