J Reconstr Microsurg 2022; 38(06): 441-450
DOI: 10.1055/s-0041-1735224
Original Article

Assessing the Influence of Failed Implant Reconstruction on Patient Satisfaction and Decision Regret after Salvage Free-Flap Breast Reconstruction

Ronnie L. Shammas#
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Health System, Durham, North Carolina
,
Amanda R. Sergesketter#
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Health System, Durham, North Carolina
,
Mahsa Taskindoust
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Health System, Durham, North Carolina
,
Sonali Biswas
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Health System, Durham, North Carolina
,
Scott T. Hollenbeck
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Health System, Durham, North Carolina
,
Brett T. Phillips
1   Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Health System, Durham, North Carolina
› Author Affiliations

Abstract

Background Free-flap breast reconstruction after failed implant reconstruction is associated with improved patient outcomes. How the level of satisfaction achieved compares between patients with and without previously failed implant reconstruction remains unknown. The aim of this study was to assess the influence of prior failed implant-based reconstruction on long-term patient-reported outcomes after free-flap breast reconstruction.

Methods All patients undergoing free-flap breast reconstruction between 2015 and 2019 were identified. Patient satisfaction using the BREAST-Q and decisional regret using the Decision Regret Scale were compared between patients with and without a history of implant breast reconstruction.

Results Overall, 207 patients were contacted and 131 completed the BREAST-Q and Decision Regret Scale. A total of 23 patients had a history of failed implant-based reconstruction requiring free-flap-flap salvage, most commonly due to infection (39.1%), chronic pain (34.8%), capsular contracture (26%), and implant malposition (26.1%). Following definitive free-flap reconstruction, patients with prior failed implant reconstruction had significantly lower BREAST-Q scores for satisfaction with breast (61.2 ± 16.7 vs. 70.4 ± 18.7; p = 0.04) and sexual well-being (38.5 ± 18.2 vs. 52.8 ± 24.7; p = 0.01) and reported higher decision regret (19.1 ± 18.6 vs. 9.6 ± 15.6, respectively). There were no significant differences for psychosocial well-being (p = 0.67), physical well-being (chest; p = 0.27), and physical well-being (abdomen; p = 0.91).

Conclusion A history of failed implant-based reconstruction is associated with reduced satisfaction and increased decision regret with the final reconstructive outcome. This data underscores the importance of appropriate patient selection at the initial consultation, and informed preoperative counseling regarding long-term outcomes in patients presenting for free-flap reconstruction after a failed implant-based reconstruction.

# These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 28 March 2021

Accepted: 19 July 2021

Article published online:
23 August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Nelson JA, Allen Jr. RJ, Polanco T. et al. Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients. Ann Surg 2019; 270 (03) 473-483
  • 2 Panchal H, Matros E. Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg 2017; 140 (5S Advances in Breast Reconstruction#x0029;: 7S-13S
  • 3 Serletti JM, Fosnot J, Nelson JA, Disa JJ, Bucky LP. Breast reconstruction after breast cancer. Plast Reconstr Surg 2011; 127 (06) 124e-135e
  • 4 Zhao R, Tran BNN, Doval AF. et al. A multicenter analysis examining patients undergoing conversion of implant-based breast reconstruction to abdominally based free tissue transfer. J Reconstr Microsurg 2018; 34 (09) 685-691
  • 5 Levine SM, Lester ME, Fontenot B, Allen Sr RJ. Perforator flap breast reconstruction after unsatisfactory implant reconstruction. Ann Plast Surg 2011; 66 (05) 513-517
  • 6 Coriddi M, Shenaq D, Kenworthy E. et al. Autologous breast reconstruction after failed implant-based reconstruction: evaluation of surgical and patient-reported outcomes and quality of life. Plast Reconstr Surg 2019; 143 (02) 373-379
  • 7 Visser NJ, Damen THC, Timman R, Hofer SOP, Mureau MAM. Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction. Plast Reconstr Surg 2010; 126 (01) 26-36
  • 8 Ali SR, Holmes WJM, Quinn M, Emam AT, Prousskaia E, Wilson SM. Tertiary breast reconstruction for salvage of the failed implant-based reconstruction using the deep inferior epigastric perforator flap. J Reconstr Microsurg 2018; 34 (09) e1-e2
  • 9 Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124 (02) 345-353
  • 10 Brehaut JC, O'Connor AM, Wood TJ. et al. Validation of a decision regret scale. Med Decis Making 2003; 23 (04) 281-292
  • 11 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 12 Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q. Plast Reconstr Surg 2017; 139 (05) 1046e-1055e
  • 13 AMOC. User manual-decision regret scale. Accessed August 2, 2021 at: https://decisionaid.ohri.ca/docs/develop/User_manuals/UM_Regret_Scale.pdf
  • 14 Wee CE, Younis J, Isbester K. et al. Understanding breast implant illness, before and after explantation: a patient-reported outcomes study. Ann Plast Surg 2020; 85 (S1, suppl 1): S82-S86
  • 15 Wilkins EG, Hamill JB, Kim HM. et al. Complications in postmastectomy breast reconstruction: one-year outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) study. Ann Surg 2018; 267 (01) 164-170
  • 16 Lam TC, Borotkanics R, Hsieh F, Salinas J, Boyages J. Immediate two-stage prosthetic breast reconstruction failure: radiation is not the only culprit. Plast Reconstr Surg 2018; 141 (06) 1315-1324
  • 17 Albornoz CR, Cohen WA, Razdan SN. et al. The impact of travel distance on breast reconstruction in the United States. Plast Reconstr Surg 2016; 137 (01) 12-18
  • 18 Roughton MC, DiEgidio P, Zhou L, Stitzenberg K, Meyer AM. Distance to a plastic surgeon and type of insurance plan are independently predictive of postmastectomy breast reconstruction. Plast Reconstr Surg 2016; 138 (02) 203e-211e
  • 19 Albornoz CR, Matros E, McCarthy CM. et al. Implant breast reconstruction and radiation: a multicenter analysis of long-term health-related quality of life and satisfaction. Ann Surg Oncol 2014; 21 (07) 2159-2164
  • 20 Zhong T, Hu J, Bagher S. et al. Decision regret following breast reconstruction: the role of self-efficacy and satisfaction with information in the preoperative period. Plast Reconstr Surg 2013; 132 (05) 724e-734e
  • 21 Lee CN, Belkora J, Chang Y, Moy B, Partridge A, Sepucha K. Are patients making high-quality decisions about breast reconstruction after mastectomy? [outcomes article]. Plast Reconstr Surg 2011; 127 (01) 18-26
  • 22 Lee CN, Ubel PA, Deal AM. et al. How informed is the decision about breast reconstruction after mastectomy?: a prospective, cross-sectional study. Ann Surg 2016; 264 (06) 1103-1109
  • 23 Flitcroft K, Brennan M, Spillane A. Decisional regret and choice of breast reconstruction following mastectomy for breast cancer: a systematic review. Psychooncology 2018; 27 (04) 1110-1120
  • 24 Albino FP, Patel KM, Smith JR, Nahabedian MY. Delayed versus delayed-immediate autologous breast reconstruction: a blinded evaluation of aesthetic outcomes. Arch Plast Surg 2014; 41 (03) 264-270
  • 25 Momoh AO, Ahmed R, Kelley BP. et al. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol 2014; 21 (01) 118-124
  • 26 Velazquez C, Siska RC, Pestana IA. Breast reconstruction completion in the obese: does reconstruction technique make a difference in its achievement?. J Reconstr Microsurg 2021; 37 (09) 720-727