title: Understanding the recovery phase of breast reconstructions: Patient-reported outcomes correlated to the type and timing of reconstruction.
abstract: BACKGROUND
  During preoperative discussions with breast reconstruction patients, questions often arise about what to expect during the recovery period. However, there is a paucity of data elucidating post-breast reconstruction pain, fatigue, and physical morbidity. This information is important to patient and physician understanding of reconstructive choices and the postoperative recovery process. We sought to evaluate how recovery may vary for patients based on the timing and type of reconstruction.
  
  
  METHODS
  Patients were recruited as part of the Mastectomy Reconstruction Outcomes Consortium (MROC) study, which is a prospective, multicentered National Institute of Health (NIH)-funded study (1RO1CA152192). Here, patients completed the Numerical Pain Rating Scale (NPRS), McGill Pain Questionnaire, and Breast-Q preoperatively, at 1 week, and 3 months postoperatively. Pain, fatigue, and upper body morbidity were evaluated by the type and timing of reconstruction.
  
  
  RESULTS
  A total of 2013 MROC study participants had completed a 3-month follow-up, and therefore they were included for the analysis. A total of 1583 (78.6%) and 1517 patients (75.3%) completed surveys at 1 week and 3 months, respectively, post reconstruction. Across all procedure groups, fatigue and physical well-being scores did not return to preoperative levels by 3 months. At 3 months, pain measured by the NPRS differed across procedure types (P = 0.01), with tissue expander/implant (TE/I) having more pain than direct to implant (P < 0.01). Similarly, at 3 months, chest and upper body physical morbidity, as measured by BREAST-Q, differed by procedure types (P < 0.001), with generally less morbidity for autologous reconstruction as compared with TE/Is.
  
  
  CONCLUSIONS
  For all reconstructive procedure groups, patients did not fully recover at 3 months post surgery. In addition, postoperative pain and upper body physical morbidity vary significantly by reconstructive procedure with patients undergoing TE/I reporting the most distress.
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Department of Surgery, Montefiore Medical Center, 1776 Eastchester Road, New York, NY, 10461, USA.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.affiliation: Section of Plastic and Reconstructive Surgery, The Department of Surgery, University of Michigan, 1500 E. Medical Center Dr. Ann Arbor, MI, 48109, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hamill
authors.affiliation: Center for Statistical Consultation and Research, University of Michigan, 915 E. Washington St., Ann Arbor, MI, 48109, USA.
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Center for Statistical Consultation and Research, University of Michigan, 915 E. Washington St., Ann Arbor, MI, 48109, USA.
authors.forename: Xiaoxue
authors.initials: X
authors.lastname: Chen
authors.affiliation: Section of Plastic and Reconstructive Surgery, The Department of Surgery, University of Michigan, 1500 E. Medical Center Dr. Ann Arbor, MI, 48109, USA.
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, MRI Suite 10065, New York, NY, 10065, USA. Electronic address: pusica@mskcc.org.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
mesh_terms: D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D011446:Prospective Studies; D013524:Surgical Flaps; D015625:Tissue Expansion Devices
keywords: BREAST-Q; Breast reconstruction; Fatigue; Pain; Physical distress; Recovery