BACKGROUND:This review aimed to meta-analyze the quality of life of alloplastic versus autologous breast reconstruction, when measured with the BREAST-Q.
METHODS:An electronic PubMed and EMBASE ...search was designed to find articles that compared alloplastic versus autologous breast reconstruction using the BREAST-Q. Studies that failed to present BREAST-Q scores and studies that did not compare alloplastic versus autologous breast reconstruction were excluded. Two authors independently extracted data from the included studies. A standardized data collection form was used. Quality was assessed using the Newcastle-Ottawa Scale. The mean difference and 95 percent confidence intervals between breast reconstruction means were estimated for each BREAST-Q subscale. Forest plots and the I statistic were used to assess heterogeneity and funnel plot publication bias. The Z test was used to assess overall effects.
RESULTS:Two hundred eighty abstracts were found; 10 articles were included. Autologous breast reconstruction scored significantly higher in the five subscales than alloplastic breast reconstruction. The Satisfaction with Breasts subscale indicated the greatest difference, with a mean difference of 6.41 (95 percent CI, 3.58 to 9.24; I = 70 percent). The Satisfaction with Results subscale displayed a mean difference of 5.52. The Sexual Well-Being subscale displayed a mean difference of 3.85. The Psychosocial Well-Being subscale displayed a mean difference of 2.64. The overall difference in physical well-being was significant, with high heterogeneity (mean difference, 3.33; 95 percent CI, 0.18 to 6.48; I = 85).
CONCLUSION:Autologous breast reconstruction had superior outcomes compared with alloplastic breast reconstruction as measured by the BREAST-Q.
Purpose
The aim of this study was to develop a patient decision aid (pDA) that could support patients with breast cancer (BC) in making an informed decision about breast reconstruction (BR) after ...mastectomy.
Methods
The development included four stages: (i) Establishment of a multidisciplinary team; (ii) Needs assessment consisting of semi‐structured interviews in patients and a survey among healthcare professionals (HCPs); (iii) Creation of content, design and technical system; and (iv) Acceptability and usability testing using a think‐aloud approach in patients and interviews among HCPs and representatives of the Dutch Breast Cancer Patient Organization.
Results
From the needs assessment, three themes were identified: Challenging period to make a decision, Diverse motivations for a personal decision and Information needed to make a decision about BR. HCPs valued the development of a pDA, especially to prepare patients for consultation. The pDA that was developed contained three parts: first, a consultation sheet for oncological breast surgeons to introduce the choice; second, an online tool including an overview of reconstructive options, the pros and cons of each option, information on the consequences of each option for daily life, exercises to clarify personal values and patient stories; and third, a summary sheet with patients’ values, preferences and questions to help inform and guide the discussion between the patient and her plastic surgeon. The pDA was perceived to be informative, helpful and easy to use by patients and HCPs.
Conclusion
Consistent with information needs, a pDA was developed to support patients with BC who consider immediate BR in making an informed decision together with their plastic surgeon.
Patient or Public Contribution
Patients participated in the needs assessment and in acceptability and usability testing.
The aim of this prospective multi-center study was to evaluate whether autologous breast reconstruction (BR) leads to lower short-term Quality of Life (QoL) compared to alloplastic BR, due the more ...physically demanding surgery and increased risk of severe complications of autologous BR.
Changes in QoL following BR were measured in this prospective multi-center study using the Breast-Q questionnaire which was administered preoperatively, and at six weeks and six months postoperatively. Characteristics and complications, classified according to Clavien-Dindo (CD), were compared between alloplastic and autologous groups. Profile plots and generalized Linear regression models were constructed to analyze the Breast-Q subscales over time for both BR groups.
Preoperatively, women undergoing autologous BR scored lower on all Breast-Q scales compared to women undergoing alloplastic BR, regardless whether they underwent immediate or delayed BR. Women undergoing autologous BR scored higher at six weeks and six months postoperative on "satisfaction with breasts" (p=0.001), "psychosocial well-being" (p=0.024) and "sexual well-being" (p=0.007). Postoperative "physical well-being: chest" was similar between both groups (p=0.533). CD grade ≥III complications occurred more often among women in the autologous group (27% versus 12%, p=0.042). Complications were not associated with worse Breast-Q scores on any of the subscales.
In contrast to our expectations and despite the higher incidence of severe complications and lower preoperative breast satisfaction and QoL scores, women undergoing autologous BR have higher levels of breast satisfaction, and psychosocial and sexual well-being, both at six weeks and six months after BR compared to women undergoing alloplastic BR.
BACKGROUNDThe aim of this prospective multicenter study was to evaluate whether autologous breast reconstruction (BR) leads to lower short-term quality of life (QoL) compared with alloplastic BR, due ...to the more physically demanding surgery and increased risk of severe complications of autologous BR.METHODSChanges in QoL after BR were measured in this prospective multicenter study using the BREAST-Q questionnaire, which was administered preoperatively and at 6 weeks and 6 months postoperatively. Characteristics and complications, classified according to Clavien-Dindo, were compared between alloplastic and autologous groups. Profile plots and generalized linear regression models were constructed to analyze the BREAST-Q subscales over time for both BR groups.RESULTSPreoperatively, women undergoing autologous BR scored lower on all BREAST-Q scales compared with women undergoing alloplastic BR, regardless of whether they underwent immediate or delayed BR. Women undergoing autologous BR scored higher at 6 weeks and 6 months postoperatively on the Satisfaction with Breasts ( P = 0.001), Psychosocial Well-Being ( P = 0.024), and Sexual Well-Being ( P = 0.007) subscales. Postoperative Physical Well-Being: Chest score was similar between the groups ( P = 0.533). Clavien-Dindo grade III or higher complications occurred more often among women in the autologous group (27% versus 12%, P = 0.042). Complications were not associated with worse BREAST-Q scores on any of the subscales.CONCLUSIONSIn contrast to the authors' expectations, and despite the higher incidence of severe complications and lower preoperative breast satisfaction and QoL scores, women undergoing autologous BR had higher levels of breast satisfaction and psychosocial and sexual well-being, both at 6 weeks and 6 months after BR, compared with women undergoing alloplastic BR.CLINICAL QUESTION/LEVEL OF EVIDENCETherapeutic, II.
Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate ...breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC).
Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision aid for BC patients considering immediate breast reconstruction after mastectomy were analyzed. Participants completed questionnaires assessing sociodemographic and clinical characteristics, decisional conflict and other patient-reported outcomes related to decision-making such as breast reconstruction preference, knowledge, information resources used, preferred involvement in decision-making, information coping style, and anxiety. Multivariable logistic regression analysis was performed to identify factors associated with CSDC (score > 37.5 on decisional conflict).
Of the 250 participants, 68% experienced CSDC. Patients with a slight preference for breast reconstruction (odds ratio (OR) = 6.19, p < .01), with no preference for or against breast reconstruction (OR = 11.84, p < .01), and with a strong preference for no breast reconstruction (OR = 5.20, p < .05) were more likely to experience CSDC than patients with a strong preference for breast reconstruction. Furthermore, patients with more anxiety were more likely to experience CSDC (OR = 1.03, p = .01).
A majority of BC patients who consider immediate breast reconstruction after mastectomy experience clinically significant decisional conflict. The findings emphasize the need for decision support, especially for patients who do not have a strong preference for breast reconstruction.
•A majority of patients considering immediate breast reconstruction experience decisional conflict.•Patients without a strong preference for breast reconstruction are more likely to experience decisional conflict.•Patients with more anxiety are more likely to experience decisional conflict.
PURPOSE: Breast cancer patients face complex decisions about immediate breast reconstruction (BR) after mastectomy. We evaluated the efficacy of an online decision aid in improving the ...decision-making process, decision quality and health outcomes in breast cancer patients considering immediate BR. METHODS: In a multicenter randomized controlled trial, patients were allocated to either the intervention group receiving care-as-usual (CAU) with access to an online decision aid, or the control group receiving CAU with an information leaflet. The primary outcome was decisional conflict. Secondary outcomes assessed the process of decision making (e.g. preparation for decision making, satisfaction with information), decision quality (decision regret, knowledge) and health outcomes (e.g. satisfaction with BR outcomes, body image). Patients completed questionnaires at baseline (T0), 1 week after consultation with a plastic surgeon (T1), 3 months (T2), and 12 months post-surgery (T3). RESULTS: We included 250 patients. Decisional conflict decreased over time in both groups, with no between group differences. Intervention participants felt better prepared for decision making than controls ( P = .002). At T2, 87% of intervention participants were (very) satisfied with the information about BR, compared to 73% of control participants ( P = .011). No significant between group differences were observed in any other outcome. CONCLUSION: Our online decision aid was as effective in reducing decisional conflict as an information leaflet about immediate BR after mastectomy. However, the decision aid substantially improved the decision-making process by better preparing breast cancer patients for decisions about immediate BR.
OBJECTIVETo assess whether a suture technique in upper blepharoplasty may be the cause of differences in the occurrence of suture abscess formation and focal inflammation.
MATERIALS AND METHODSA ...Level I, randomized controlled trial. The upper blepharoplasty wound was closed with a running intradermal suture. External intradermal suturing implied that this suture was started by initially passing it through the intact skin adjacent to the wound. In contrast, internal intradermal suturing meant the intradermal suture was not started in the adjacent skin but simply within the wound itself. One week and 6 weeks after surgery, the presence of suture abscesses and focal inflammation was assessed at the entrance and exit of the sutures.
RESULTSAfter 1 week, 12 abscesses (40.0%) were found at the medial side of the externally sutured upper eyelids and 4 abscesses (13.3%) in the internally sutured upper eyelids (p = .02). The presence of erythema and edema after 1 week was also significantly lower in internally sutured upper eyelids (p = .02).
CONCLUSIONIn this series, the method of starting the suture (internal vs external) at the medial side of an upper blepharoplasty wound was associated with a statistically significant reduction in the incidence of medial wound inflammation and suture abscess formation at a 1-week follow-up.
Upper eyelid blepharoplasty generally is performed as a combination of excess skin reduction and fat resection. Fat resection can in the long term result in a hollow orbit. Therefore, treatment of ...the lax orbital septum, in combination with skin reduction, seems a more preferable approach than fat resection. The authors describe a technique of upper-eyelid blepharoplasty: a combination of excess skin reduction and shortening of the stretched lax orbital septum by means of bipolar coagulation. This procedure is called bipolar coagulation-assisted orbital septoblepharoplasty, ie, BICO septoblepharoplasty. The aim of this retrospective study is to report on our initial experience with this technique.
We retrospectively analyzed 296 patients in whom an upper-eyelid blepharoplasty was performed during the past 4 years using the BICO septoblepharoplasty technique: first, excess skin is removed, then a small rim of orbicularis muscle is excised to expose the bulging orbital septum, and finally, before closure of the wound, bipolar coagulation of the exposed orbital septum is performed. This results in shrinkage of the septum and thus in repositioning of the pseudoherniated fat pads.
At discharge from follow-up, which varied from 9 weeks (72% of the patients) up till 2 years after surgery (28% of the patients), in all patients ultimately a satisfactory result was achieved and ultimately all were satisfied or very satisfied with the result of the procedure. There were only 3 patients with minor complications: 1 patient with a slightly retracting scar, which resolved spontaneously, and 2 patients with slight asymmetry requiring additional skin resection.
BICO septoblepharoplasty of the upper eyelid seems to be an effective way to treat blepharochalasia of the upper eyelid; the bipolar coagulation of the orbital septum will lead to shrinkage of the septum, thereby repositioning the prolapsing medial and central fat pads. Secondary fibrosis will reinforce the orbital septum postoperatively.
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