Patient-Related Risk Factors for Worsened Abdominal Well-Being after Autologous Breast Reconstruction.

BACKGROUND Patient-reported lower satisfaction with the abdomen preoperatively is a strong predictor of undergoing a DIEP flap. We evaluated physical well-being of the abdomen before and after flap-based breast reconstruction to determine potential predictors for decreased postoperative abdominal well-being. METHODS We retrospectively analyzed a institutional breast reconstruction registry, selecting patients who underwent abdominally-based autologous flap breast reconstruction from 2010 to 2015. Our primary outcome was the Physical Well-being of the Abdomen (PWA) domain from the Breast-Q, measured preoperatively and at 6- and 12-month follow-up visits after final reconstruction. We classified two patient groups: those who experienced a clinically-important worsening of PWA and those who did not. We used Chi-squared test, t-test, and Wilcoxon rank-sum test, and multivariable logistic regression to identify potential predictors. RESULTS We identified 142 women, of which 74 (52%) experienced a clinically-important worsening of PWA, whereas 68 (48%) did not. The first group experienced a 25-point (95% CI:22-28) decrease and the latter an 8-point (95% CI:5-10) decrease in PWA compared to baseline. Our multivariable analysis showed an association between higher baseline PWA and race with higher odds of decreased PWA at the 12-month follow-up. A higher baseline RAND-36 general health score, bilateral reconstruction, and a lower BMI demonstrated a trend for clinically-important worsening of PWA. CONCLUSIONS Our results show that more than half of flap-based breast reconstruction patients experienced clinically-important worsening of abdominal well-being pre- to post-final breast reconstruction. Clinicians may use these findings to identify patients at higher risk of worsened postoperative abdominal well-being.

[1]  E. Wilkins,et al.  Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study , 2017, Plastic and reconstructive surgery.

[2]  T. Zhong,et al.  Patient-Centered Breast Reconstruction Based on Health-Related Quality-of-Life Evidence. , 2018, Clinics in plastic surgery.

[3]  K. Butler,et al.  Preoperative Computed Tomographic Angiogram Measurement of Abdominal Muscles Is a Valuable Risk Assessment for Bulge Formation after Microsurgical Abdominal Free Flap Breast Reconstruction , 2017, Plastic and reconstructive surgery.

[4]  Min-Jeong Cho,et al.  Predictors, Classification, and Management of Umbilical Complications in DIEP Flap Breast Reconstruction , 2017, Plastic and reconstructive surgery.

[5]  M. Rosenbaum,et al.  How Socioeconomic Status Affects Patient Perceptions of Health Care: A Qualitative Study , 2017, Journal of primary care & community health.

[6]  T. Stern,et al.  Racial and Ethnic Diversity in the US Psychiatric Workforce: A Perspective and Recommendations , 2016, Academic Psychiatry.

[7]  B. Munder,et al.  Myosonographic study of abdominal wall dynamics to assess donor site morbidity after microsurgical breast reconstruction with a DIEP or an ms-2 TRAM flap. , 2016, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[8]  M. Velten,et al.  Long-Term Follow-Up of Quality of Life following DIEP Flap Breast Reconstruction , 2016, Plastic and reconstructive surgery.

[9]  A. Shaterian,et al.  Patient Race and Provider Predict Patient Satisfaction Following Post-Mastectomy Breast Reconstruction , 2016, World journal of plastic surgery.

[10]  Wess A. Cohen,et al.  The BREAST-Q in surgical research: A review of the literature 2009-2015. , 2016, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[11]  Taik-jong Lee,et al.  The Low DIEP Flap: An Enhancement to the Abdominal Donor Site , 2016, Plastic and reconstructive surgery.

[12]  K. Oh,et al.  Donor site morbidity following DIEP flap for breast reconstruction in Asian patients: Is it different? , 2015, Microsurgery.

[13]  A. Klassen,et al.  Interpreting clinical differences in BREAST-Q scores: minimal important difference. , 2014, Plastic and reconstructive surgery.

[14]  J. Niddam,et al.  DIEP flap for breast reconstruction: retrospective evaluation of patient satisfaction on abdominal results. , 2014, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[15]  J. Macdermid,et al.  Development of a breast reconstruction satisfaction questionnaire (BRECON‐31): Principal components analysis and clinimetric properties , 2012, Journal of surgical oncology.

[16]  C. Nastala,et al.  Abdominal Wall Stability and Flap Complications after Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Does Body Mass Index Make a Difference? Analysis of 418 Patients and 639 Flaps , 2012, Plastic and reconstructive surgery.

[17]  Bernard T. Lee,et al.  Comparison of Morbidity, Functional Outcome, and Satisfaction following Bilateral TRAM versus Bilateral DIEP Flap Breast Reconstruction , 2009, Plastic and reconstructive surgery.

[18]  A. Alderman,et al.  A Systematic Review of Abdominal Wall Function Following Abdominal Flaps for Postmastectomy Breast Reconstruction , 2009, Annals of plastic surgery.

[19]  P. Cordeiro,et al.  Development of a New Patient-Reported Outcome Measure for Breast Surgery: The BREAST-Q , 2009, Plastic and reconstructive surgery.

[20]  W. Rozen,et al.  Avoiding Denervation of Rectus Abdominis in DIEP Flap Harvest: The Importance of Medial Row Perforators , 2008, Plastic and reconstructive surgery.

[21]  Liza C. Wu,et al.  Comparison of Donor-Site Morbidity of SIEA, DIEP, and Muscle-Sparing TRAM Flaps for Breast Reconstruction , 2008, Plastic and reconstructive surgery.

[22]  J. P. Watson,et al.  Risk Factors for Abdominal Donor-Site Morbidity in Free Flap Breast Reconstruction , 2008, Plastic and reconstructive surgery.

[23]  D. Chang,et al.  Comparison of Donor-Site Complications and Functional Outcomes in Free Muscle-Sparing TRAM Flap and Free DIEP Flap Breast Reconstruction , 2006, Plastic and reconstructive surgery.

[24]  R. Gemperli,et al.  Clinical Outcome of Abdominal Wall after DIEP Flap Harvesting and Immediate Application of Abdominoplasty Techniques , 2005, Plastic and reconstructive surgery.

[25]  Angela Fagerlin,et al.  Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. , 2005, Health services research.

[26]  B. Momen,et al.  Breast Reconstruction with the DIEP Flap or the Muscle-Sparing (MS-2) Free TRAM Flap: Is There a Difference? , 2005, Plastic and reconstructive surgery.

[27]  B. Momen,et al.  Lower Abdominal Bulge After Deep Inferior Epigastric Perforator Flap (DIEP) Breast Reconstruction , 2005, Annals of plastic surgery.

[28]  P. Manson,et al.  Contour Abnormalities of the Abdomen after Breast Reconstruction with Abdominal Flaps: The Role of Muscle Preservation , 2002, Plastic and reconstructive surgery.

[29]  L. Morales,et al.  The RAND-36 measure of health-related quality of life , 2001, Annals of medicine.

[30]  S. Mitchell,et al.  A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap. , 2000, British journal of plastic surgery.

[31]  D. Larson,et al.  Rectus abdominis muscle innervation: implications for TRAM flap elevation. , 1995, Plastic and reconstructive surgery.

[32]  S. S. Kroll,et al.  A comparison of outcomes using three different methods of breast reconstruction. , 1992, Plastic and reconstructive surgery.

[33]  S. S. Kroll,et al.  Comparison of Strategies for Preventing Abdominal‐Wall Weakness after TRAM Flap Breast Reconstruction , 1992, Plastic and reconstructive surgery.

[34]  P. Santi,et al.  Long-term Evaluation of the Abdominal Wall Competence after Total and Selective Harvesting of the Rectus Abdominis Muscle , 1992, Annals of plastic surgery.