title: Long-term quality-of-life assessment following one-stage immediate breast reconstruction using biodimensional expander implants: the patient's perspective.
abstract: BACKGROUND
  Biodimensional devices may provide a superior breast form when an implant is considered for immediate breast reconstruction for breast cancer. The authors prospectively report patient perception of outcome using a permanent anatomical expander implant following a planned one-stage procedure.
  
  
  METHODS
  The Quality of Life Questionnaire BR-23 was modified to measure body image perception, physical effects, cancer worry, and surgical choice. Responses were classified into four categories. A subset of patients completed the questionnaire 1 and 6 years after surgery. Data were compared using nonparametric analyses.
  
  
  RESULTS
  One hundred ten patients were studied, with a mean follow-up of 63 months (range, 25 to 108 months); 46 patients had submuscular implant reconstruction and 64 had an implant-assisted latissimus dorsi flap. The mean patient age was 46 years (range, 20 to 76 years). There was no difference in patient perception of outcome between the two groups, although the latissimus dorsi group found it easier to fit into bras (p = 0.03, Mann-Whitney test). For patient perception of body image, the median score was within the most favorable category in four of six fields. Restricted arm movement and pain in the treated breast had resolved completely by 5 years after surgery. More than 80 percent of patients would choose the same surgical option if the cancer scenario presented itself again.
  
  
  CONCLUSIONS
  A biodimensional permanent expander implant, when used appropriately, can achieve high levels of patient satisfaction. The authors' data provide long-term outcome measures with which to counsel patients about one-stage implant-assisted immediate breast reconstruction using an anatomical device.
authors.affiliation: London, United Kingdom From Academic Surgery (Breast Unit) and the Department of Information Technology and Statistics, Royal Marsden NHS Foundation Trust.
authors.forename: Gerald P H
authors.initials: GPH
authors.lastname: Gui
authors.forename: Geeta
authors.initials: G
authors.lastname: Kadayaprath
authors.forename: Su-Ming
authors.initials: SM
authors.lastname: Tan
authors.forename: Eleni C
authors.initials: EC
authors.lastname: Faliakou
authors.forename: Christina
authors.initials: C
authors.lastname: Choy
authors.forename: Ann
authors.initials: A
authors.lastname: Ward
authors.forename: Roger
authors.initials: R
authors.lastname: A'Hern
mesh_terms: D000328:Adult; D000368:Aged; D001828:Body Image; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D015625:Tissue Expansion Devices