title: Outcomes of Breast Reconstruction After Mastectomy Using Tissue Expander and Implant Reconstruction.
abstract: OBJECTIVE
  Considerable attention has been given to patient-reported outcomes in breast reconstruction. The objective of this study is to evaluate the effect of postreconstruction change in breast volume on validated patient satisfaction survey scores.
  
  
  METHODS
  Patients undergoing skin-sparing mastectomy followed by tissue expander/implant reconstruction between July 2010 and July 2014 by a single surgeon were given postoperative patient-reported satisfaction surveys (BREAST-Q). Retrospective chart review of patients with completed surveys was undertaken to record patient characteristics and compare preoperative breast volume (extrapolated from mastectomy mass) with postoperative implant volume, and percent change in volume was calculated. Regressions were utilized to correlate percent change with satisfaction in each category.
  
  
  RESULTS
  A total of 160 patient surveys were included. Sixty-five percent of breasts analyzed had increased volume after reconstruction, whereas 35% had decreased volume. The increased volume group had significantly lower body mass index (P = 0.0001) and was significantly younger (P = 0.009) than the decreased volume group. Patients who experienced increase in breast volume reported statistically greater satisfaction with breasts (P = 0.019), overall outcome (P = 0.012), sexual well-being (P = 0.002), and information (P = 0.042) compared with the decreased volume group. Moreover, linear regression revealed that as percent change increased, so did satisfaction with outcome (P = 0.02), sexual well-being (P = 0.005), information (P = 0.018), and surgeon (P = 0.036). Notably, there was not a significant difference in complication rate (P = 0.146) or tumor margin (0.914) between the groups.
  
  
  CONCLUSIONS
  Patients who undergo tissue expander/implant breast reconstruction with final implants that are larger in volume than their native breasts have increased patient satisfaction scores in several categories without increase in complication rate or difference in tumor margin. There is a positive linear relationship between percent change and patient satisfaction.
authors.affiliation: From the *Division of Plastic Surgery, Department of Surgery, †Morsani College of Medicine, University of South Florida; ‡Breast Surgical Oncology Moffitt Cancer Center; and §Tampa General Circle, Tampa, FL.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Huber
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Zemina
authors.forename: Bugra
authors.initials: B
authors.lastname: Tugertimur
authors.forename: Sequoya R
authors.initials: SR
authors.lastname: Killebrew
authors.forename: Augustine Reid
authors.initials: AR
authors.lastname: Wilson
authors.forename: Johnathon V
authors.initials: JV
authors.lastname: DallaRosa
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Prabhakaran
authors.forename: Deniz
authors.initials: D
authors.lastname: Dayicioglu
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000033:anatomy & histology* / Q000601:surgery; D019928:Breast Implantation / Q000295:instrumentation / Q000379:methods*; D018427:Breast Implants; D005260:Female; D006801:Humans; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D009929:Organ Size; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015626:Tissue Expansion / Q000295:instrumentation / Q000379:methods*; D015625:Tissue Expansion Devices