title: Patient-Reported Satisfaction and Quality of Life following Breast Reconstruction in Thin Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients.
abstract: BACKGROUND
  Patients undergoing autologous breast reconstruction have higher long-term satisfaction rates compared with those undergoing prosthetic reconstruction. Regardless, most patients still undergo prosthetic reconstruction. The authors compared outcomes of microsurgical reconstruction to those of prosthetic reconstruction in thin patients and evaluated the effect of reconstructive type on quality of life.
  
  
  METHODS
  After institutional review board approval was obtained, the authors reviewed all patients undergoing breast reconstruction at a single institution from November of 2007 to May of 2012. Thin patients (body mass index <22 kg/m) were included for analysis and divided into two cohorts: microsurgical reconstruction and tissue expander/implant reconstruction. Once identified, patients were mailed a BREAST-Q survey for response; a retrospective chart review was also conducted.
  
  
  RESULTS
  A total of 273 patients met inclusion criteria: 81.7 percent (n = 223) underwent tissue expander/implant reconstruction and 18.3 percent (n = 50) underwent microsurgical reconstruction. Of the patients undergoing microsurgical reconstruction, 50 percent (n = 25) responded to the BREAST-Q survey, whereas 48.4 percent of patients (n = 108) with implant reconstruction were responders. Microsurgical patients required more secondary revision [48 percent (n = 12) versus 25.9 percent (n = 28)] and autologous fat grafting [32 percent (n = 8) versus 16.9 percent (n = 19)] and a greater volume of fat per injection (147.85 ml versus 63.9 ml; p < 0.001). Furthermore, BREAST-Q responses showed that these patients were more satisfied with their breasts (71.1 percent versus 64.9 percent; p = 0.004), but had similar overall satisfaction with reconstruction (73.0 percent versus 74.8 percent; p = 0.54).
  
  
  CONCLUSIONS
  Microsurgical breast reconstruction is efficacious in patients with a body mass index less than 22 kg/m and, when compared with prosthetic reconstruction, results in higher satisfaction with breasts. However, it requires more secondary revision surgery and the use of autologous fat grafting as an adjunct.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Bronx, New York, and New Hyde Park, N.Y.; and Munich, Germany From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein School of Medicine; the Department of Plastic, Reconstructive, Hand, and Burn Surgery, Klinikum Bogenhausen Teaching Hospital, Technical University Munich; the Department of Plastic Surgery, New York University Langone Medical Center; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Hosftra University/North Shore Long Island Jewish Medical Center.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.forename: P Niclas
authors.initials: PN
authors.lastname: Broer
authors.forename: Vishal D
authors.initials: VD
authors.lastname: Thanik
authors.forename: Stelios C
authors.initials: SC
authors.lastname: Wilson
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
authors.forename: Mihye
authors.initials: M
authors.lastname: Choi
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
authors.forename: Alexes
authors.initials: A
authors.lastname: Hazen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D064171:Superficial Back Muscles / Q000637:transplantation; D013524:Surgical Flaps / Q000098:blood supply; D013851:Thinness; D014182:Transplantation, Autologous; D016896:Treatment Outcome