title: Tracking the aesthetic outcomes of prosthetic breast reconstructions that have complications.
abstract: BACKGROUND
  Aesthetic results following breast reconstruction have been shown to be a major contributor to patient satisfaction. While many presume that complications after reconstruction impact final aesthetic results, little data exist to substantiate this putative relationship.
  
  
  OBJECTIVE
  To track and evaluate aesthetic outcomes following implant reconstructions with complications.
  
  
  METHODS
  A chart review was conducted on a series of consecutive expander-implant breast reconstructions performed by the senior author between 2004 and 2012. Included patients completed their prosthetic reconstruction or converted to autologous methods and had a minimum follow-up period of 130 days. Four blinded members of the division of plastic surgery independently rated postoperative anterior photographs of patients' breasts using a validated scoring scale with respect to five distinct aesthetic domains: breast mound volume, contour, placement, scarring and inframammary fold.
  
  
  RESULTS
  Of the 172 patients who met the inclusion criteria, 36 experienced a complication. The tissue expander in one-half of these patients was salvaged and the remaining patients converted to autologous reconstruction. The average aesthetic scores for each domain did not differ significantly between patients who experienced a complication and retained their expander and those who did not experience a complication. Patients who converted to autologous tissue reconstruction after experiencing a complication had the highest aesthetic scores.
  
  
  CONCLUSIONS
  The ability to obtain aesthetic results following a complication that were not statistically different from results in those without complications may reflect the surgeon's refined attempt to salvage the initial implant reconstruction; in other circumstances, the improved cosmesis was achieved through conversion to an autologous tissue-based method.
  
  
  CONCLUSIONS
  The present study quantitatively assessed the impact of complications on aesthetic outcomes following implant breast reconstruction. Continuance of prosthetic reconstruction and conversion to autologous reconstruction serve as viable options to obtain adequate aesthetic scores following a complication. Information gained from the present analysis will help manage patient expectations.
authors.affiliation: Vanderbilt University School of Medicine, Chicago, Illinois, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Mioton
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Akhil
authors.initials: A
authors.lastname: Seth
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gaido
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: John Ys
authors.initials: JY
authors.lastname: Kim
keywords: Aesthetic; Breast reconstruction; Outcomes; Prosthetic
references.citation: Plast Reconstr Surg. 2008 Jun;121(6):1886-1892
references.pmid: 18520873
references.citation: Plast Reconstr Surg. 2000 Oct;106(5):1014-25; discussion 1026-7
references.pmid: 11039373
references.citation: Plast Reconstr Surg. 1992 Sep;90(3):455-62
references.pmid: 1387483
references.citation: Plast Reconstr Surg. 2012 Jun;129(6):909e-918e
references.pmid: 22634689
references.citation: Plast Reconstr Surg. 2011 Apr;127(4):1428-1436
references.pmid: 21460651
references.citation: Plast Reconstr Surg. 2010 Jun;125(6):1585-1595
references.pmid: 20517080
references.citation: Plast Reconstr Surg. 2001 Feb;107(2):350-351
references.pmid: 11242363
references.citation: J Gen Intern Med. 2006 Feb;21(2):177-80
references.pmid: 16606377
references.citation: Int J Radiat Oncol Biol Phys. 2001 Mar 1;49(3):713-21
references.pmid: 11172953
references.citation: Scand J Plast Reconstr Surg Hand Surg. 2000 Jun;34(2):167-71
references.pmid: 10900634
references.citation: Breast. 2010 Dec;19(6):521-6
references.pmid: 21078486
references.citation: J Am Coll Surg. 2004 Oct;199(4):531-7
references.pmid: 15454134
references.citation: Cancer. 1991 Sep 1;68(5 Suppl):1170-5
references.pmid: 1913501
references.citation: Ann Plast Surg. 1990 Oct;25(4):249-57
references.pmid: 2147095
references.citation: Plast Reconstr Surg. 2012 Aug;130(2):254e-264e
references.pmid: 22842422
references.citation: J Plast Reconstr Aesthet Surg. 2012 Aug;65(8):1064-71
references.pmid: 22475685
references.citation: Ann Surg Oncol. 2001 Aug;8(7):586-91
references.pmid: 11508620
references.citation: Psychosomatics. 1993 May-Jun;34(3):241-50
references.pmid: 8493306
references.citation: Am J Med. 2003 Nov;115(7):515-20
references.pmid: 14599629
references.citation: Plast Reconstr Surg. 2004 Mar;113(3):877-81
references.pmid: 15108879
references.citation: Ann Plast Surg. 1982 Oct;9(4):321-5
references.pmid: 7149564
references.citation: Am J Med Qual. 1995 Spring;10(1):48-54
references.pmid: 7727988
references.citation: J Plast Surg Hand Surg. 2012 Oct;46(5):349-53
references.pmid: 22931105
references.citation: Plast Reconstr Surg. 1997 Mar;99(3):686-91
references.pmid: 9047187
references.citation: Plast Reconstr Surg. 2001 Jun;107(7):1702-9
references.pmid: 11391188
references.citation: Plast Reconstr Surg. 2003 Jan;111(1):125-38; discussion 139-40
references.pmid: 12496573
references.citation: Plast Reconstr Surg. 2006 Sep 15;118(4):832-839
references.pmid: 16980843
references.citation: Plast Reconstr Surg. 2002 Jun;109(7):2265-74
references.pmid: 12045548