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- Gümüscü, Rojda, et al.
(author)
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National long-term patient-reported outcomes following mastectomy with or without breast reconstruction : The Swedish Breast Reconstruction Outcome Study Part 2 (SweBRO 2)
- 2024
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In: BJS Open. - : Oxford University Press. - 2474-9842. ; 8:1
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Journal article (peer-reviewed)abstract
- Background: The Swedish Breast Reconstruction Outcome Study (SweBRO) initiative is a nationwide study with the primary aim of assessing long-term outcomes after mastectomy with and without breast reconstruction (BR). The current part (SweBRO 2) is designed to evaluate health-related quality of life (HRQoL), with the hypothesis that BR has a positive impact on patient-reported HRQoL in the long-term.Methods: Women who underwent mastectomy in Sweden in 2000, 2005, or 2010 and were alive at the time of the survey were identified through the National Breast Cancer Registry. Eligible participants received formal invitation letters to take part in a survey evaluating their HRQoL at 5 , 10, or 15 years post-mastectomy. The EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-3L questionnaires were employed.Results: Of 2904 respondents (50% of 5853 invited), 895 (31%) had received BR. Among them, 516 (58%) were reconstructed with implants and 281 (31%) with autologous tissue. Women with BR scored significantly better in the EORCT QLQ-C30 physical functioning domain (mean 90 versus 81 points), fatigue (mean 21 versus 25), and dyspnoea (mean 16 versus 22) compared to non-reconstructed women. The EORTC QLQ-BR23 revealed that women with BR experienced favourable sexual functioning compared with non-reconstructed women (mean 26 versus 14). The EQ-5D-3L visual analogue scale score was similar between groups.Conclusion: The current study underscores the benefits of BR for long-term well-being, for example, in terms of physical and sexual functioning. These underline the importance of informing women undergoing mastectomy about BR alternatives and its potential benefits in enhancing long-term well-being. The Swedish Breast Reconstruction Outcome Study (SweBRO) initiative is a nationwide study with the primary aim of assessing long-term outcomes after mastectomy with and without breast reconstruction (BR). Women who had undergone mastectomy in Sweden in 2000, 2005, or 2010 and were alive at the time of the survey were identified through the National Breast Cancer Registry. The current study underscores the benefits of BR for long-term well-being, for example, in terms of physical and sexual functioning.
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| 2. |
- Svee, Andreas, et al.
(author)
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Long-term Donor Site-related Quality of Life after Deep Inferior Epigastric Perforator Flap Breast Reconstruction
- 2024
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In: Plastic and Reconstructive Surgery - Global Open. - : Ovid Technologies (Wolters Kluwer Health). - 2169-7574. ; 12:7
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Journal article (peer-reviewed)abstract
- Background:Current knowledge about patients' perceptions of the donor site following abdominal-based breast reconstruction and its effect on health-related quality of life (HRQoL) several years after breast reconstruction is limited. This study aimed to assess the long-term effects of deep inferior epigastric perforator (DIEP) flap breast reconstruction on HRQoL, specifically focusing on the abdomen and donor site aspects.Methods:This retrospective cohort study compared 66 women who underwent DIEP breast reconstruction between 2000 and 2007 with a matched control cohort of 114 women who underwent therapeutic mastectomies without reconstruction in the year 2005. The DIEP cohort of patients completed the BREAST-Q Reconstruction module during an outpatient visit in 2015-2016. The control cohort completed the same questionnaire online in 2016.Results:The follow-up time was at least 8 years (mean 11.4 +/- 1.6 years) postreconstruction for the DIEP cohort and 10 years postmastectomy (mean 11.0 +/- 0.3 years) for the control cohort. In the DIEP cohort, 93% reported no donor site pain, 89% had no difficulty sitting up, and 91% had no activity limitations 2 weeks before completing the survey. Patients undergoing DIEP were more satisfied with their abdominal appearance than the control group (adjusted OR, 5.7; 95% confidence interval 1.8-17.6).Conclusions:A decade postoperatively, DIEP breast reconstruction yields high abdominal donor site satisfaction, with comparable abdominal physical well-being to nonreconstructed women.
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| 3. |
- Unukovych, Dmytro, et al.
(author)
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Breast reconstruction patterns from a Swedish nation-wide survey
- 2020
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In: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 46:10, s. 1867-1873
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Journal article (peer-reviewed)abstract
- ObjectivesThe overall aim of the Swedish Breast Reconstruction Outcome Study was to investigate national long-term outcomes after mastectomy with or without breast reconstruction. The current report evaluates breast reconstruction (BR) patterns in Sweden over time.Materials and methodsThis is a cross-sectional, registry-based study where all women operated with mastectomy 2000, 2005, 2010 were identified (N = 5853). Geographical differences in type of BR were investigated using heatmaps. Distribution of continuous variables were compared using the Mann-Whitney U test, categorical variables were compared using the chi-square test.ResultsMean age at survey was 69 years (SD=±11.4) and response rate was 50%, responders were on average six years younger than the non-responders and had a more favourable tumor stage (both p < 0.01). Of the 2904 responders, 31% (895/2904) had received a BR: implant-based in 58% (516/895)autologous in 31% (281/895). BR was immediate in 20% (176/895) and delayed in 80% (719/895) women.Women with BR were on average one year older, more often had a normal BMI, reported to be married or had a partner, had a higher educational level and a higher annual income when compared to those without BR (all p < 0.001). The independent factors of not receiving BR were older age and given radiotherapy.ConclusionsTo our knowledge, this is the first national long-term follow-up study on women undergoing mastectomy with and without BR. Around 30% of the survey responders have had a BR with a significant geographical variation highlighting the importance of information, availability and standardisation of indications for BR.
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| 4. |
- Unukovych, Dmytro
(author)
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Different aspects of breast reconstruction : contralateral prophylactic mastectomy, postmastectomy radiotherapy, complications after biomaterials injection
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The advances in breast reconstruction and oncoplastic surgery have positively affected the cosmetic and functional outcomes without compromising oncological safety. In this thesis, different aspects and challenges of reconstruction of the breast have been addressed. Specifically, reconstructive outcomes and quality of life after contralateral prophylactic mastectomy in women with a personal and family history of breast cancer, the role of implant reconstruction in postmastectomy radiotherapy, and the management of complications after polyacrylamide gel injections are discussed. In article I the clinical course of bilateral breast reconstruction and possible influence of adjuvant treatment were addressed in a consecutive series of patients with a personal and family history of breast cancer undergoing contralateral prophylactic mastectomy (CPM) during 1998-2008 (n=91). The findings indicated that CPM was a complex procedure, where the majority of patients (82%) received concurrent bilateral breast reconstruction. In addition, during the 3.9 years follow-up period more than half of the patients required at least one reconstruction-related operation. The clinical course after bilateral breast reconstruction was predominantly affected by operations on the cancer side, and reoperation was associated with radiotherapy. A protocol for management of patients opting for CPM and bilateral breast reconstruction is highly demanded. In article II the psychosocial outcomes of CPM with reconstruction in patients with a personal and family history of breast cancer were assessed. In this prospective questionnaire study no negative changes in health-related quality of life, sexuality or body image were found. At the 2-year postoperative assessment, the patients showed a satisfactory quality of life similar to women in general population. However, CPM could have a negative impact on the particular aspects of body image including dissatisfaction with the body, appearance, scars, femininity, and attractiveness. Women considering CPM should be informed about the possible psychosocial implications and outcomes of the operation. In article III the impact of immediate breast reconstruction with implants on dose distribution of radiotherapy was addressed in a cohort study of patients with (n=162) and without (n=558) breast implants. Overall, there was no difference in radiation doses to the organs at risk (ipsilateral lung and heart) between the two groups of patients. The presence of breast implants during radiotherapy planning was not associated with increased doses to ipsilateral lung and heart or decreased coverage of the target volume. Further studies specifically addressing consequences of radiotherapy with the longer follow-up will shed light on oncologic safety aspects. In article IV the results from a retrospective multicenter study from Ukraine on patients with complications after breast augmentation with polyacrylamide gel (n=106) were evaluated. The injections were found to have caused irreversible damage to the breast in previously healthy women as they presented with multiple symptoms as pain (80%), breast deformity (73%), lumps (54%), and gel migration (37%). All patients necessitated gel removal with complex debridement operations; 39% with partial mastectomy, 7% with subcutaneous mastectomy; and 72% required a subsequent breast reconstruction. Public awareness of the potential hazards associated with injectables is warranted.
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| 5. |
- Unukovych, Dmytro, et al.
(author)
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Predictors of Reoperations in Deep Inferior Epigastric Perforator Flap Breast Reconstruction
- 2016
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In: Plastic and Reconstructive Surgery - Global Open. - 2169-7574. ; 4:8
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Journal article (peer-reviewed)abstract
- BACKGROUND: The deep inferior epigastric perforator (DIEP) procedure is regarded a safe option for autologous breast reconstruction. Reoperations, however, may occur, and there is no consensus in the literature regarding the risk factors. The aim of this study was to identify factors associated with reoperations in DIEP procedure.PATIENTS AND METHODS: A retrospective study of consecutive patients undergoing DIEP breast reconstruction 2007 to 2014 was performed and included a review of 433 medical charts. Surgical outcome was defined as any unanticipated reoperation requiring return to the operating room. Multivariate regression analysis was utilized to identify predictors of reoperation. The following factors were considered: age, body mass index, comorbidity, childbearing history, previous abdominal surgery, adjuvant therapy, reconstruction laterality and timing, flap and perforator characteristics, and number and size of veins.RESULTS: In total, 503 free flaps were performed in 433 patients, 363 (83.8%) unilateral and 70 (16.2%) bilateral procedures. Mean age was 51 years; 15.0% were obese; 13.4% had hypertension; 2.3% had diabetes; 42.6% received tamoxifen; 58.8% had preoperative radiotherapy; 45.6% had abdominal scars. Reoperation rate was 15.9% (80/503) and included flap failure, 2.0%; partial flap loss, 1.2%; arterial thrombosis, 2.0%; venous thrombosis, 0.8%; venous congestion, 1.2%; vein kinking, 0.6%. Other complications included bleeding, 2.2%; hematoma, 3.0%; fat necrosis, 2.8%, and infection, 0.2%. Factors negatively associated with reoperation were childbearing history (odds ratio [OR]: 3.18, P = 0.001) and dual venous drainage (OR: 1.91, P = 0.016); however, only childbearing remained significant in the multivariate analyses (OR: 4.56, P = 0.023).CONCLUSIONS: The history of childbearing was found to be protective against reoperation. Number of venous anastomoses may also affect reoperation incidence, and dual venous drainage could be beneficial in nulliparous patients.
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