title: Unilateral breast reconstruction after mastectomy - patient satisfaction, aesthetic outcome and quality of life.
abstract: BACKGROUND
  An increasing number of women undergo a breast reconstruction (BR) after treatment for breast cancer. The aim of the present study was to evaluate patient-reported esthetic satisfaction, quality of life (QoL), and the association between these, following different types of BR.
  
  
  METHODS
  All women who underwent unilateral BR in Central Denmark Region between January 2005 and July 2011 were included. Participants were sent a questionnaire package, which included the Body Image Scale, The Beck Depression Inventory, the Impact of Event Scale, and a study-specific patient-reported esthetic satisfaction scale. Additionally, patients were asked if they experienced a change in QoL owing to the BR. Based on reconstructive method and timing, participants were divided into four groups, three delayed: an abdominal flap group, a latissimus dorsi flap group, an implant ± thoracodorsal flap group; and one immediate BR group.
  
  
  RESULTS
  Of 166 eligible participants, a total of 144 women (87%) completed the questionnaire. The mean follow-up was 3.8 years. Esthetic satisfaction differed significantly between groups [F(3,139) = 8.55; p < 0.001], with abdominal flap recipients reporting the highest levels of esthetic satisfaction. No between-group differences were observed for the remaining psychosocial measures. Higher satisfaction with esthetic outcome was associated with reporting higher QoL owing to the BR (odds ratio 1.10, p<0.001; 95% CI 1.06-1.15).
  
  
  CONCLUSIONS
  Abdominal flap recipients expressed higher satisfaction with their esthetic outcome, compared to the remaining BR types. Higher esthetic satisfaction was strongly associated with reporting an experience of higher QoL.
authors.affiliation: a Plastic Surgery Research Unit, Department of Plastic and Breast Surgery , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Juhl
authors.affiliation: b The Psychooncology Research Unit , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Christensen
authors.affiliation: b The Psychooncology Research Unit , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Robert
authors.initials: R
authors.lastname: Zachariae
authors.affiliation: a Plastic Surgery Research Unit, Department of Plastic and Breast Surgery , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Tine E
authors.initials: TE
authors.lastname: Damsgaard
mesh_terms: D000328:Adult; D000368:Aged; D001828:Body Image; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D011795:Surveys and Questionnaires