title: Implant breast reconstruction and radiation: a multicenter analysis of long-term health-related quality of life and satisfaction.
abstract: BACKGROUND
  Indications for radiotherapy in breast cancer treatment are expanding. Long-term satisfaction and health-related quality of life (HR-QOL), important outcomes after alloplastic breast reconstruction and radiation, have not been measured in irradiated patients by using a condition-specific, validated patient-reported outcomes instrument. The aim was to evaluate patient satisfaction and HR-QOL in patients with implant breast reconstruction and radiotherapy.
  
  
  METHODS
  A multicenter cross-sectional survey of patients who underwent implant-based breast reconstruction from three centers in the United States and Canada, with and without radiation, was performed. Satisfaction with breasts, satisfaction with outcome, psychosocial well-being, sexual well-being, and physical well-being outcomes were evaluated using the BREAST-Q(©) (Reconstruction Module). Multivariable analysis was performed to evaluate the effect of radiotherapy on patient satisfaction with breasts with adjustment by patient and treatment characteristics.
  
  
  RESULTS
  The response rate was 71 %, with 633 completed questionnaires returned. Mean follow-up was 3.3 years for irradiated patients (n = 219) and 3.7 years for nonirradiated patients (n = 414). Patients with radiation had significantly lower satisfaction with breasts (58.3 vs. 64.0; p < 0.01), satisfaction with outcome (66.8 vs. 71.4; p < 0.01), psychosocial well-being (66.7 vs. 70.9; p < 0.01), sexual well-being (47.0 vs. 52.3; p < 0.01), and physical well-being (71.8 vs. 75.1; p < 0.01) compared with nonirradiated patients. Multivariable analysis confirmed the negative effect of radiotherapy on satisfaction with breasts (β = -2.6; p = 0.03) when adjusted for patient and treatment factors.
  
  
  CONCLUSIONS
  Radiotherapy has a negative effect on HR-QOL and satisfaction with breasts in patients with implant reconstruction compared with nonirradiated patients. The information provided here can inform decision-making and help set appropriate expectations for patients undergoing implant breast reconstruction and radiation.
authors.affiliation: Plastic and Reconstructive Surgical Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Albornoz
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.forename: Anne
authors.initials: A
authors.lastname: Klassen
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Cano
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
authors.forename: Nancy
authors.initials: N
authors.lastname: VanLaeken
authors.forename: Peter
authors.initials: P
authors.lastname: Lennox
authors.forename: Sheina A
authors.initials: SA
authors.lastname: Macadam
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
mesh_terms: D019928:Breast Implantation; D001943:Breast Neoplasms / Q000523:psychology* / Q000532:radiotherapy / Q000601:surgery; D002170:Canada; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008875:Middle Aged; D009367:Neoplasm Staging; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires