A comparison of reconstructive outcomes following rotation flap approach (RoFA) versus standard mastectomy: a randomized controlled trial.

BACKGROUND: The rotation flap approach (RoFA) mastectomy is a skin-sparing technique that actively imports skin to the centre of the skin envelope and therefore aids in achieving natural ptosis to the reconstructed breast. The objective of this study was to compare clinical outcomes, aesthetics, patient satisfaction and health-related quality of life between the ROFA mastectomy and standard mastectomy approach. METHODS: This study is a prospective randomised controlled trial of participants undergoing mastectomy using either the RoFA technique or standard technique with breast reconstruction. The BREAST-Q was administered pre-operatively and at 3-, 6-, 9- and 12-months following mastectomy. A panel assessment of clinical photographs was conducted to score aesthetics and outcomes of reconstruction. RESULTS: A total of 100 participants were enrolled in the study; of these, 51 underwent RoFA incision, 47 underwent standard incision and 2 were lost to follow up. There were no statistically significant differences in BREAST-Q scores or panellist assessment between the mastectomy groups following breast reconstruction. The post-operative incidence of mastectomy skin flap tip necrosis was high in the RoFA incision group, with rates of other complications such as seroma being similar. CONCLUSION: The RoFA skin-sparing mastectomy incision showed no significant difference in results across patient-reported outcomes or aesthetics when compared to the standard approach, however, did rate higher for skin flap tip necrosis.

Normative data for the BREAST-Q Reconstruction module in an Australian population and comparison with US norms and breast reconstruction patient outcomes.

BACKGROUND: Normative data for interpreting the BREAST-Q reconstruction module are currently limited to the US population. This study aimed to generate normative BREAST-Q data from women in the Australian general population and compare it to US norms. Secondary aims were to compare normative scores to those of women undergoing breast reconstruction post-mastectomy. METHODS: Women aged 18 years and older without a history of breast cancer or breast surgery were recruited according to the Australian Census-derived population distribution. Participants completed the pre-operative BREAST-Q Reconstruction module and provided socio-demographic information. A comparison was made to a breast reconstruction patient cohort and published US norms. RESULTS: BREAST-Q data were obtained from 500 women. Mean BREAST-Q scores were as follows: Satisfaction with Breasts (Aus. 50.4 ± 15.2, US 57.8 ± 18.4), Psychosocial Well-being (Aus. 55.4 ± 15.8, US 70.7 ± 17.6), Physical Well-being Chest (Aus. 78.5 ± 14.8, US 92.6 ± 10.7), Physical Well-being Abdomen (Aus. 76.1 ± 19.6, US 78.1 ± 20.3) and Sexual Well-being (Aus. 41.5 ± 20.6, US 56.5 ± 8.2). Australian women with a higher BMI or chronic health condition reported lower scores for four of the five BREAST-Q scales. Lower scores were reported by younger women for Psychosocial Well-being and Sexual Well-being. Mean BREAST-Q scores for the Australian population were significantly lower than US norms in four of the five scales. When compared to normative data, breast reconstruction patients had significantly higher BREAST-Q scores post-operatively in all scales except for Physical Well-being Chest. CONCLUSION: This study derived only the second set of normative scores for the BREAST-Q reconstruction module reported globally and found that significant differences exist between populations.

Does nipple-areolar tattooing matter in breast reconstruction? A cohort study using the BREAST-Q.

BACKGROUND: Breast reconstruction is achieved through a series of surgical procedures often concluded with nipple-areolar reconstruction tattoo. The purpose of the tattoo is to increase the patients' satisfaction with the appearance of the breast, however, no published studies quantitatively compare patient satisfaction before vs. after tattoo. In recent times nurse practitioners are increasingly performing this specialised procedure previously undertaken by the plastic surgeon, but there is no evidence to compare patient satisfaction according to clinician. PURPOSE: The objectives of this study are to examine patient satisfaction pre- and post-nipple-areolar tattooing utilising a validated patient-reported outcome measure the BREAST-Q, and to identify any differences in patient satisfaction between the nurse practitioner and plastic surgeon. METHODS: Data was collected from all breast reconstruction patients who underwent nipple-areolar reconstruction tattooing over a six-year period in a dedicated Breast Reconstruction Unit and had completed a pre- and post-tattoo BREAST- Q questionnaire. Analysis of data included paired t-test of pre- and post-tattoo scores and ANCOVA to compare clinicians and tattoo laterality. RESULTS: 93 patients with completed pre- and post-tattoo questionnaires within the date criteria were included from the 204 patientswho had a nipple-areolar tattoo. There was a significant improvement in patient satisfaction with nipple reconstruction from pre-tattoo (m = 74.4) to post-tattoo (m = 81.0), p = 0.013 (2-tailed), with no significant difference between clinicians. CONCLUSION: Patients reported through completion of the BREAST-Q, that nipple-areolar tattooing significantly improves satisfaction with their nipple reconstruction.

Determinants of breast reconstruction outcome: How important is volume symmetry?

Breast reconstruction has established psychosocial benefit compared to mastectomy alone. Evaluation of determinants of breast reconstruction outcome has previously been limited by lack of high quality, condition-specific, patient-reported outcomes measures. The BREAST-Q is such a measure and is well suited to comparison against objective measurements of reconstructed breasts such as volume and volume symmetry. A cohort of patients who had undergone breast reconstruction over a 14 year period underwent assessment of their breast reconstructions using a 3D laser scanning technique and at the same time completed the BREAST-Q patient reported outcomes measure. The objective data derived from the 3D laser scans were then compared to the quantitative data from the patient-reported outcomes measure. Internal comparisons between domains of the BREAST-Q were also examined. 119 patients completed the study. No correlation was found between objectively measured post-operative volume symmetry and patient reported satisfaction with breasts. Examination of a specific question of the BREAST-Q established that patients did notice if they had breast asymmetry but that this did not translate into dissatisfaction with the breasts overall. Patients who had second stage surgery to correct asymmetry, however, did have a statistically significant increase in satisfaction with breasts between pre and post-symmetrization measures. The strongest correlation for a high level of satisfaction with the reconstructed breast(s) was high level of satisfaction with pre-operative information given. Although symmetrization procedures are valuable for increasing satisfaction with breasts, breast volume symmetry is not a major determinant of outcome in breast reconstruction. The breast reconstruction 'process' is more important in determining patients' post-operative well-being and satisfaction with their overall outcome than the actual final 'product' of their reconstruction.

Autologous fat grafting for whole breast reconstruction.

SUMMARY: This is the first reported case of a patient who had a single-stage large-volume breast reconstruction with autologous fat grafting, following rotation flap approach (RoFA) mastectomy. The purpose of this case study was to evaluate the viability of reconstruction of the breast by autologous fat grafting alone, in the context of RoFA mastectomy. The hypothesis was that there would be minimal interval loss of autologous fat on the whole breast reconstruction side. Right RoFA mastectomy was used for resection of an invasive primary breast cancer and resulted in the right breast skin envelope. Eleven months later, the patient underwent grafting of 400 ml of autologous fat into the skin envelope and underlying pectoralis major muscle. Outcome was assessed by using a validated 3D laser scan technique for quantitative breast volume measurement. Other outcome measures included the BREAST-Q questionnaire and 2D clinical photography. At 12-month follow-up, the patient was observed to have maintenance of volume of the reconstructed breast. Her BREAST-Q scores were markedly improved compared with before fat grafting, and there was observable improvement in shape, contour, and symmetry on 2D clinical photography. The 2 new techniques, RoFA mastectomy and large-volume single-stage autologous fat grafting, were used in combination to achieve a satisfactory postmastectomy breast reconstruction. Novel tools for measurement of outcome were the 3D whole-body laser scanner and BREAST-Q questionnaire. This case demonstrates the potential for the use of fat grafting for reconstruction. Outcomes in a larger patient populations are needed to confirm these findings.